Provider Demographics
NPI:1306281472
Name:SIMPSON, ALICIA C (MS, RD, LD, IBCLC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:C
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MS, RD, LD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CHURCH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3330
Mailing Address - Country:US
Mailing Address - Phone:678-607-6052
Mailing Address - Fax:404-850-1362
Practice Address - Street 1:215 CHURCH ST STE 112
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3330
Practice Address - Country:US
Practice Address - Phone:678-607-6052
Practice Address - Fax:404-850-1362
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004064133N00000X, 133VN1004X, 133V00000X
GAL-46587174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137551AMedicaid
GA003137551AMedicaid