Provider Demographics
NPI:1700284502
Name:SIMPSON, CODY ALLEN (SFA)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:ALLEN
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:SFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 STONEHENGE DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-7366
Mailing Address - Country:US
Mailing Address - Phone:662-671-0242
Mailing Address - Fax:
Practice Address - Street 1:401 SOUTHCREST CIR STE 203
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6719
Practice Address - Country:US
Practice Address - Phone:662-536-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access