Provider Demographics
NPI:1033120639
Name:NEWSOM, TODD CHRISTOPHER (DPM)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:CHRISTOPHER
Last Name:NEWSOM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CANAL ST STE 703
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4291
Mailing Address - Country:US
Mailing Address - Phone:912-988-3323
Mailing Address - Fax:912-988-3612
Practice Address - Street 1:114 CANAL ST STE 703
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4291
Practice Address - Country:US
Practice Address - Phone:912-988-3323
Practice Address - Fax:912-988-3612
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA000911213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC205284392OtherTAX ID SC
GA000927011CMedicaid
GA571157698OtherTAX ID NUMBER
SCAA17878685Medicare UPIN
GA000927011CMedicaid
GA48SCCLNMedicare PIN