Provider Demographics
NPI:1962640979
Name:ARTHUR J SIMON MD LLC
Entity type:Organization
Organization Name:ARTHUR J SIMON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER OF SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-350-9355
Mailing Address - Street 1:3193 HOWELL MILL RD NW
Mailing Address - Street 2:STE 328
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2119
Mailing Address - Country:US
Mailing Address - Phone:404-350-9355
Mailing Address - Fax:404-350-9069
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:STE 328
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-350-9355
Practice Address - Fax:404-350-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00404049AMedicaid
GA00404049AMedicaid