Provider Demographics
NPI:1811256704
Name:SIMPSON, TABETHA LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:TABETHA
Middle Name:LEIGH
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1725
Mailing Address - Fax:
Practice Address - Street 1:6909 PROSPERITY CHURCH RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6698
Practice Address - Country:US
Practice Address - Phone:704-384-1425
Practice Address - Fax:704-384-1426
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC201500534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCAC5385578-R826OtherDEA
NC182903OtherRESIDENT TRAINING LICENSE