Healthcare Provider Details

I. General information

NPI: 1699949677
Provider Name (Legal Business Name): JAMES A SIMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23065 SAMS RIDGE RD
LIGNUM VA
22726-2060
US

IV. Provider business mailing address

23065 SAMS RIDGE RD
LIGNUM VA
22726-2060
US

V. Phone/Fax

Practice location:
  • Phone: 540-219-7793
  • Fax:
Mailing address:
  • Phone: 540-219-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number2705096948
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: