Healthcare Provider Details

I. General information

NPI: 1689077968
Provider Name (Legal Business Name): LAURA SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 4TH ST
BRUNSWICK GA
31520-3714
US

IV. Provider business mailing address

2747 4TH ST
BRUNSWICK GA
31520-3714
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-3961
  • Fax: 912-279-3349
Mailing address:
  • Phone: 912-264-3961
  • Fax: 912-279-3349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN069921
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: