Provider Demographics
NPI:1275623480
Name:SIMPSON, MARY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2335
Mailing Address - Country:US
Mailing Address - Phone:706-321-0476
Mailing Address - Fax:706-321-2508
Practice Address - Street 1:1310 13TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2335
Practice Address - Country:US
Practice Address - Phone:706-321-0476
Practice Address - Fax:706-321-2508
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant