Provider Demographics
NPI:1780652719
Name:SIMPSON, MICHAEL ROSS (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROSS
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:
Practice Address - Street 1:5570 COUGAR TRAIL RD
Practice Address - Street 2:SUITE 320
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3849
Practice Address - Country:US
Practice Address - Phone:757-955-2828
Practice Address - Fax:757-955-2829
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52301207Q00000X
VA0102201994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780652719Medicaid
VAP01392243Medicare PIN
VAVV2634AMedicare PIN
VAVV2634BMedicare PIN