Skip Navigation

Provider Information for 1104067834



MS. JENNIFER ANN SIMPSON LMT, IANMT, CFT/CMT

Gender: FEMALE

Individual NPI: 1104067834

Calendar Last Updated: 2013-10-03

Details

Name Value
NPI 1104067834
Enumeration Date 2009-03-09
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 300 W HOSPITAL RD
FORT GORDON, GA 30905-5741
United States

Phone: 706-787-2840 | Fax:
View Map External Link
Primary Practice Address 300 W HOSPITAL RD
FORT GORDON, GA 30905-5741
United States

Phone: 706-787-2840 | Fax:
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 172M00000X - Mechanotherapist GA MT000675
Other Identifiers
Issuer State Number
MEDICAID GA 582478355
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location