Provider Demographics
NPI:1407220379
Name:SIMPSON SURGERY GROUP, LLC
Entity Type:Organization
Organization Name:SIMPSON SURGERY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:404-556-3543
Mailing Address - Street 1:PO BOX 20275
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30325-0275
Mailing Address - Country:US
Mailing Address - Phone:404-556-3543
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:701 HIGHLAND AVE NE APT 1407
Practice Address - Street 2:#1407
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1454
Practice Address - Country:US
Practice Address - Phone:404-556-3543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5338363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty