Provider Demographics
NPI:1972306165
Name:SIMPSON, JACATO T (MSW)
Entity type:Individual
Prefix:MR
First Name:JACATO
Middle Name:T
Last Name:SIMPSON
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-1822
Mailing Address - Country:US
Mailing Address - Phone:912-381-7172
Mailing Address - Fax:
Practice Address - Street 1:1113 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-1822
Practice Address - Country:US
Practice Address - Phone:912-381-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool