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General NPI Number Information
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NPI Number | 1770586968
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Entity Type | Organization
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Legal Business Name | SIMPSONVILLE FAMILY MEDICINE, PA
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 1336 HIGHWAY 14
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City | SIMPSONVILLE
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State | SC
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Zip | 29681
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Country | US
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Telephone | 864-527-8600
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Fax | 864-527-8638
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Provider Business Mailing Address
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Address Line | 1336 HIGHWAY 14
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City | SIMPSONVILLE
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State | SC
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Zip | 29681
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Country | US
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Telephone | 864-527-8600
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Fax | 864-527-8638
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DAWN M BATES
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Credential |
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Telephone | 864-527-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16070
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License Number State | SC
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