Healthcare Provider Details

I. General information

NPI: 1801978929
Provider Name (Legal Business Name): JIMMY SIMPSON FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9558 N HIGHWAY 27
ROCK SPRING GA
30739-2113
US

IV. Provider business mailing address

PO BOX 69
ROCK SPRING GA
30739-0069
US

V. Phone/Fax

Practice location:
  • Phone: 706-375-9520
  • Fax: 706-375-9521
Mailing address:
  • Phone: 706-375-9520
  • Fax: 706-375-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. VICKIE S. HODGE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 706-375-9520