Healthcare Provider Details

I. General information

NPI: 1902824329
Provider Name (Legal Business Name): THOMAS E SIMPSON MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HIGHLAND OAKS DR SUITE 200
WINSTON SALEM NC
27103-7114
US

IV. Provider business mailing address

760 HIGHLAND OAKS DR STE 200
WINSTON SALEM NC
27103-7114
US

V. Phone/Fax

Practice location:
  • Phone: 336-659-9440
  • Fax: 336-659-9292
Mailing address:
  • Phone: 336-659-9440
  • Fax: 336-659-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number39466
License Number StateNC

VIII. Authorized Official

Name: DR. THOMAS E SIMPSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 336-659-9440