MEDICARE: SAMUEL CARL NEWSOME MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20171	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023000239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL CARL NEWSOME MD

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27102-0344
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-983-6921

Provider Business Practice Location Address
First Line	:	304 MOUNTAIN VIEW RD
Second Line	:
City	:	KING
State	:	NC
Zip	:	27021-8768
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-983-6921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	01/26/2011

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