Provider Demographics
NPI:1801864525
Name:SIMPSON, JOSETTE M (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSETTE
Middle Name:M
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOSETTE
Other - Middle Name:M
Other - Last Name:HWANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 465446
Mailing Address - Street 2:ANESTHESIA DEPT
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30042-5446
Mailing Address - Country:US
Mailing Address - Phone:770-237-1561
Mailing Address - Fax:770-237-1124
Practice Address - Street 1:1170 CLEVELAND AVE
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3615
Practice Address - Country:US
Practice Address - Phone:404-466-1700
Practice Address - Fax:770-237-1124
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154979367500000X
MDR184304367500000X
DCRN1015953367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ49673Medicare UPIN