MEDICARE: SHARLA MICHELLE SIMPSON P.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA001994	GA

General Provider Information

NPI Number	:	1053682476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARLA MICHELLE SIMPSON P.T.A.

Provider Business Mailing Address
First Line	:	195 14TH ST NE
Second Line	:	#1403
City	:	ATLANTA
State	:	GA
Zip	:	30309-2671
Country	:	US
Telephone Number	:	404-326-0065
Fax Number	:

Provider Business Practice Location Address
First Line	:	3161 HOWELL MILL RD NW
Second Line	:	SUITE 410
City	:	ATLANTA
State	:	GA
Zip	:	30327-2135
Country	:	US
Telephone Number	:	404-352-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2012
Last Update Date	:	01/17/2012

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