Healthcare Provider Details

I. General information

NPI: 1295792562
Provider Name (Legal Business Name): EARNEST PAUL SIMS MAWUSI DPM, FACFAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 HARDY CASH DR
HAMPTON VA
23666-2400
US

IV. Provider business mailing address

1618 HARDY CASH DR
HAMPTON VA
23666-2400
US

V. Phone/Fax

Practice location:
  • Phone: 757-825-5783
  • Fax: 757-825-9658
Mailing address:
  • Phone: 757-825-5783
  • Fax: 757-825-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103000935
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: