Healthcare Provider Details

I. General information

NPI: 1114483286
Provider Name (Legal Business Name): SIMON JIAN NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1764
US

IV. Provider business mailing address

530 STEDFORD LN
DULUTH GA
30097-8007
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4747
  • Fax:
Mailing address:
  • Phone: 404-317-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN234154
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN234154
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: