Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | ||
Y | 224P00000X | Prosthetist | CO088164 | GA |
NPI | 1477116648 |
---|---|
Provider Name | Patrice Sims |
First Address | Winder, GA 30680-8373 |
Second Address | Duluth, GA 30097-4504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2019 |
Last Update Date | 15/04/2019 |