Provider Demographics
NPI:1083375992
Name:SIMERVIL, MAGDALINE
Entity Type:Individual
Prefix:
First Name:MAGDALINE
Middle Name:
Last Name:SIMERVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAGDALINE
Other - Middle Name:
Other - Last Name:GUERRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA,MA,PCT,CPT,MBA
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-0057
Mailing Address - Country:US
Mailing Address - Phone:404-855-7066
Mailing Address - Fax:
Practice Address - Street 1:10216 BRIARBAY LOOP
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-6579
Practice Address - Country:US
Practice Address - Phone:404-932-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0030022024374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide