MEDICARE: JOSETTE M. SIMPSON CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN154979	GA
2	367500000X	Certified Registered Nurse Anesthetist	R184304	MD
3	367500000X	Certified Registered Nurse Anesthetist	RN1015953	DC

General Provider Information

NPI Number	:	1801864525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSETTE M. SIMPSON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 465446
Second Line	:	ANESTHESIA DEPT
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30042-5446
Country	:	US
Telephone Number	:	770-237-1561
Fax Number	:	770-237-1124

Provider Business Practice Location Address
First Line	:	1170 CLEVELAND AVE
Second Line	:	ANESTHESIA DEPT.
City	:	EAST POINT
State	:	GA
Zip	:	30344-3615
Country	:	US
Telephone Number	:	404-466-1700
Fax Number	:	770-237-1124

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	11/19/2014

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