Provider Demographics
NPI:1831887207
Name:SIMON, NOAH JIJI (WHNP)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:JIJI
Last Name:SIMON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 OLD OCILLA RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1644
Mailing Address - Country:US
Mailing Address - Phone:229-391-3500
Mailing Address - Fax:
Practice Address - Street 1:1060 GAINES SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3198
Practice Address - Country:US
Practice Address - Phone:229-391-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN290043363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health