MEDICARE: SIMONE MARIE ANDERSON

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	363LF0000X	Family Nurse Practitioner	APRN-NP204839	GA

General Provider Information

NPI Number	:	1184176356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONE MARIE ANDERSON

Provider Business Mailing Address
First Line	:	3426 FIELDSTONE TRCE
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-6307
Country	:	US
Telephone Number	:	678-683-7988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 CLEVELAND AVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	404-755-2291
Fax Number	:

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

Provider Enumeration Date	:	11/03/2016
Last Update Date	:	10/29/2025

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