Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW005163 | GA |
NPI | 1003194713 |
---|---|
Provider Name | Dr. Omar Tremayne Sims |
First Address | Athens, GA 30603-1704 |
Second Address | Athens, GA 30601-2744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2011 |
Last Update Date | 28/05/2014 |