Provider Demographics
NPI:1871931824
Name:SIMS, ANGELA (SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 GORDY MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:CUSSETA
Mailing Address - State:GA
Mailing Address - Zip Code:31805-3721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:243 GORDY MILL POND RD
Practice Address - Street 2:
Practice Address - City:CUSSETA
Practice Address - State:GA
Practice Address - Zip Code:31805-3721
Practice Address - Country:US
Practice Address - Phone:251-769-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist