Healthcare Provider Details

I. General information

NPI: 1225034846
Provider Name (Legal Business Name): ANGELA MARQUIS SIMS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MARQUIS WESSELL PH.D.

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 FIFTEENTH AVENUE
COLUMBUS GA
31901-1608
US

IV. Provider business mailing address

2022 FIFTEENTH AVENUE
COLUMBUS GA
31901-1608
US

V. Phone/Fax

Practice location:
  • Phone: 706-649-6500
  • Fax: 706-649-6521
Mailing address:
  • Phone: 706-649-6500
  • Fax: 706-649-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY003208
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY003208
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003208
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: