Provider Demographics
NPI:1306494067
Name:NEWSOME, REBEKAH DAUGHERTY (NP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:DAUGHERTY
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 BRIARPATCH CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3899
Mailing Address - Country:US
Mailing Address - Phone:770-584-4724
Mailing Address - Fax:
Practice Address - Street 1:1825 GA-34
Practice Address - Street 2:SUITE 1200
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3026
Practice Address - Country:US
Practice Address - Phone:770-502-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner