Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 048965 | GA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 048965 | GA |
NPI | 1386653061 |
---|---|
Provider Name | Dr. Hewatt M Sims |
First Address | Douglas, GA 31533 |
Second Address | Douglas, GA 31533-2211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 13/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048965 | MEDICAL LICENSE (01) | GA |
368937772C | (05) | GA |
H64095 | (02) | GA |