Provider Demographics
NPI:1366271157
Name:NEWBORN, VIOLET A (CPRS)
Entity type:Individual
Prefix:MISS
First Name:VIOLET
Middle Name:A
Last Name:NEWBORN
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 BIGGS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38108-3227
Mailing Address - Country:US
Mailing Address - Phone:901-505-9121
Mailing Address - Fax:
Practice Address - Street 1:940 BIGGS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38108-3227
Practice Address - Country:US
Practice Address - Phone:901-505-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000-2468175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty