Provider Demographics
NPI:1326335423
Name:SIMS, JACQUELINE PAULETTE (LPN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:PAULETTE
Last Name:SIMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 AUBURN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2602
Mailing Address - Country:US
Mailing Address - Phone:404-781-5891
Mailing Address - Fax:
Practice Address - Street 1:210 AUBURN AVE NE
Practice Address - Street 2:#407
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2610
Practice Address - Country:US
Practice Address - Phone:404-781-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN034846164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse