Healthcare Provider Details

I. General information

NPI: 1598647539
Provider Name (Legal Business Name): AMANI SIMEON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MONTREAL RD
TUCKER GA
30084-6901
US

IV. Provider business mailing address

170 ROSEMOORE DR
COVINGTON GA
30014-7603
US

V. Phone/Fax

Practice location:
  • Phone: 770-638-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN301042
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: