Provider Demographics
NPI:1568413219
Name:SIMS, HARRISON G III (MD)
Entity Type:Individual
Prefix:
First Name:HARRISON
Middle Name:G
Last Name:SIMS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 WESTSIDE DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3605
Mailing Address - Country:US
Mailing Address - Phone:423-339-1760
Mailing Address - Fax:423-559-1483
Practice Address - Street 1:2620 WESTSIDE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3605
Practice Address - Country:US
Practice Address - Phone:423-339-1760
Practice Address - Fax:423-559-1483
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN037149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3880829OtherMEDICARE - INDIVIDUAL
TN1584772OtherGHI
TN3880829OtherMEDICAID - INDIVIDUAL
TNG62659OtherMEDICARE UPIN
TN3719860OtherMEDICARE - GROUP
TN3880829Medicaid
TNG62659OtherHEALTHSPRING
GA392704OtherBCBS GA - INDIVIDUAL
TN4052544OtherBCBS TN - INDIVIDUAL
TNTN0102OtherUHC RIVER VALLEY / JDHC
TNTN0102OtherUHC RIVER VALLEY / JDHC
TNG62659OtherHEALTHSPRING