Provider Demographics
NPI:1306556865
Name:SIMBANA, ALISON J
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:J
Last Name:SIMBANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:R
Other - Last Name:SIMBANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3105 CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-1282
Mailing Address - Country:US
Mailing Address - Phone:470-880-0489
Mailing Address - Fax:
Practice Address - Street 1:3105 CHELSEA LN
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-1282
Practice Address - Country:US
Practice Address - Phone:470-880-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA19011Medicaid