Provider Demographics
NPI:1740254812
Name:SIMPSON, TIMOTHY C (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:SIMPSON
Suffix:
Gender:M
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 2968
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30156-9117
Mailing Address - Country:US
Mailing Address - Phone:770-779-0015
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-851-6936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047365207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000825954GMedicaid
GA10959OtherKAISER
GA000825954Medicaid
GA000825954FMedicaid
GA598848OtherBCBS OF GEORGIA
GA10038151OtherAMERIGROUP
GA333412OtherWELLCARE OF GEORGIA
GA198024OtherBCBS OF GEORGIA
GA0000012586Other1ST MEDICAL NETWORK
GA198024OtherBCBS OF GEORGIA
GA93BBGTJMedicare ID - Type Unspecified
GA598848OtherBCBS OF GEORGIA
GAG68233Medicare UPIN