Provider Demographics
NPI:1225034846
Name:SIMS, ANGELA MARQUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARQUIS
Last Name:SIMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARQUIS
Other - Last Name:WESSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2022 FIFTEENTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1608
Mailing Address - Country:US
Mailing Address - Phone:706-649-6500
Mailing Address - Fax:706-649-6521
Practice Address - Street 1:2022 FIFTEENTH AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1608
Practice Address - Country:US
Practice Address - Phone:706-649-6500
Practice Address - Fax:706-649-6521
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003208103TC2200X, 103TM1800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493242309Medicaid
MO493242309Medicaid