Provider Demographics
NPI:1972919074
Name:SIMPSON, ANNA CAROL PORTER (ATC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CAROL PORTER
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:CAROL
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:4680 MATTHEWS PARK DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-7100
Mailing Address - Country:US
Mailing Address - Phone:863-221-2620
Mailing Address - Fax:
Practice Address - Street 1:8225 MALL PKWY STE 150
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-7103
Practice Address - Country:US
Practice Address - Phone:863-221-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT9792255A2300X
GAAT0026172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer