MEDICARE: SAMANTHA ELIZABETH SIMS MSW

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
1	104100000X	Social Worker	3017G	AL
2	1041C0700X	Clinical Social Worker	3672C	AL

General Provider Information

NPI Number	:	1750713558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ELIZABETH SIMS MSW

Provider Business Mailing Address
First Line	:	600 SUN TEMPLE DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-8643
Country	:	US
Telephone Number	:	256-975-4291
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 SUN TEMPLE DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-5919
Country	:	US
Telephone Number	:	256-975-4291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	03/15/2023

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