Provider Demographics
NPI:1891717666
Name:SIMPSON, NICOLE SPENCER (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SPENCER
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
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 200096
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-9002
Mailing Address - Country:US
Mailing Address - Phone:770-607-7339
Mailing Address - Fax:
Practice Address - Street 1:5126 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014
Practice Address - Country:US
Practice Address - Phone:770-786-7053
Practice Address - Fax:678-905-7053
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0549482085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30BDMTJMedicare ID - Type Unspecified
GAH94195Medicare UPIN