Provider Demographics
NPI:1275713372
Name:SIMS, TANIA MASHA
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:MASHA
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 CHERRY BLOSSOM WAY
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-2069
Mailing Address - Country:US
Mailing Address - Phone:404-246-1141
Mailing Address - Fax:
Practice Address - Street 1:7411 CHERRY BLOSSOM WAY
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:GA
Practice Address - Zip Code:30187-2069
Practice Address - Country:US
Practice Address - Phone:404-246-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver