Provider Demographics
NPI:1760265292
Name:SIMS, ROBERT L JR (MS, PHD - INTERN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:SIMS
Suffix:JR
Gender:M
Credentials:MS, PHD - INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 HAMPTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2482
Mailing Address - Country:US
Mailing Address - Phone:706-424-8302
Mailing Address - Fax:
Practice Address - Street 1:250 GEORGIA AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3046
Practice Address - Country:US
Practice Address - Phone:404-653-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical