Provider Demographics
NPI:1508149840
Name:SIMS, SUSAN HADAWAY (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HADAWAY
Last Name:SIMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 GOLF CLUB DR APT 2410
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5860
Mailing Address - Country:US
Mailing Address - Phone:706-773-5013
Mailing Address - Fax:
Practice Address - Street 1:7869 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1721
Practice Address - Country:US
Practice Address - Phone:706-571-9312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012636183500000X
AL10254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist