Provider Demographics
NPI:1942324470
Name:SIMPSON, LATANYA ASENATH (MD)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:ASENATH
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 1:360 E EH CRUMP BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-5310
Mailing Address - Country:US
Mailing Address - Phone:901-261-2000
Mailing Address - Fax:901-946-9262
Practice Address - Street 1:4940 HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38066-5068
Practice Address - Country:US
Practice Address - Phone:901-261-2221
Practice Address - Fax:901-946-9262
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703728Medicaid
TNH20035Medicare UPIN