Healthcare Provider Details

I. General information

NPI: 1023000239
Provider Name (Legal Business Name): SAMUEL CARL NEWSOME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MOUNTAIN VIEW RD
KING NC
27021-8768
US

IV. Provider business mailing address

PO BOX 344
WINSTON SALEM NC
27102-0344
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax: 336-983-6921
Mailing address:
  • Phone: 336-716-2255
  • Fax: 336-983-6921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20171
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: