Provider Demographics
NPI:1073795696
Name:SIMPSON, DANA WOODS (PA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:WOODS
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 RIVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2147
Mailing Address - Country:US
Mailing Address - Phone:229-241-2711
Mailing Address - Fax:229-241-2711
Practice Address - Street 1:201 WOODROW WILSON DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2538
Practice Address - Country:US
Practice Address - Phone:229-241-0041
Practice Address - Fax:229-241-0048
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant