Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 48045 | MN |
NPI | 1134106503 |
---|---|
Provider Name | Lijo Simpson |
First Address | Sandy Springs, GA 30342-1709 |
Second Address | Lake Spivey, GA 30236-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I43329 | (02) |