Provider Demographics
NPI:1699786038
Name:SIMPSON, BONNIE (RN, MSN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 OLD OCILLA RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1644
Mailing Address - Country:US
Mailing Address - Phone:229-391-3500
Mailing Address - Fax:229-391-3499
Practice Address - Street 1:1948 OLD OCILLA RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1644
Practice Address - Country:US
Practice Address - Phone:229-391-3500
Practice Address - Fax:229-391-3499
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113398363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ47785Medicare UPIN
GA50BBJMLMedicare ID - Type Unspecified