Provider Demographics
NPI:1619378049
Name:SIMPSON, MARISSA
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:
Last Name:SIMPSON
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 1:230 DUNCAN DR BLDG 1440
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31409-5107
Mailing Address - Country:US
Mailing Address - Phone:912-315-6500
Mailing Address - Fax:
Practice Address - Street 1:45 POINTER CT
Practice Address - Street 2:
Practice Address - City:ALLENHURST
Practice Address - State:GA
Practice Address - Zip Code:31301-2648
Practice Address - Country:US
Practice Address - Phone:912-755-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN076608164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse