Healthcare Provider Details

I. General information

NPI: 1316144934
Provider Name (Legal Business Name): TROY A SIMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 HARRIS FARMS WAY
AUSTELL GA
30106-8023
US

IV. Provider business mailing address

3449 HARRIS FARMS WAY
AUSTELL GA
30106-8023
US

V. Phone/Fax

Practice location:
  • Phone: 678-398-0200
  • Fax: 866-391-4798
Mailing address:
  • Phone: 678-398-0200
  • Fax: 866-391-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number2009#121500
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: