Healthcare Provider Details

I. General information

NPI: 1184862047
Provider Name (Legal Business Name): NATASHA LASHA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2847 PEARL ST
ATLANTA GA
30344-6842
US

IV. Provider business mailing address

2847 PEARL ST
ATLANTA GA
30344-6842
US

V. Phone/Fax

Practice location:
  • Phone: 770-374-7263
  • Fax:
Mailing address:
  • Phone: 770-374-7263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number07-24683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: