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NPI Code Detail

MEDICARE: SIMON VANDAGRIFF

MEDICARE: SIMON VANDAGRIFF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorC4023AAL

General Provider Information

NPI Number : 1407599574
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMON VANDAGRIFF
Provider Business Mailing Address
First Line : 115 FAIRGROUND RD
Second Line :
City : FLORENCE
State : AL
Zip : 35630-1283
Country : US
Telephone Number : 256-712-2822
Fax Number :
Provider Business Practice Location Address
First Line : 115 FAIRGROUND RD
Second Line :
City : FLORENCE
State : AL
Zip : 35630-1283
Country : US
Telephone Number : 256-712-2822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2022
Last Update Date : 04/18/2022

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Directions to “ SIMON VANDAGRIFF ” Practice Location

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