Provider Demographics
NPI:1427050467
Name:SIMPSON, JOHN R (MD, DDS, FACS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MD, DDS, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SUNSET DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2293
Mailing Address - Country:US
Mailing Address - Phone:706-546-0144
Mailing Address - Fax:706-543-9203
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2293
Practice Address - Country:US
Practice Address - Phone:706-546-0144
Practice Address - Fax:706-543-9203
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-03-16
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-05-02
Provider Licenses
StateLicense IDTaxonomies
GA031126174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00376098AMedicaid
GAE73154Medicare UPIN