Provider Demographics
NPI:1811378433
Name:SIMPSON, JILLIAN (CNA)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1562
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-1562
Mailing Address - Country:US
Mailing Address - Phone:470-298-2630
Mailing Address - Fax:
Practice Address - Street 1:789 JORDAN LN APT 2
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5715
Practice Address - Country:US
Practice Address - Phone:470-298-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030037800376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide