1770798639 NPI number — BILLY VANCE SIMS LCSW, MHP

Table of content: BILLY VANCE SIMS LCSW, MHP (NPI 1770798639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770798639 NPI number — BILLY VANCE SIMS LCSW, MHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMS
Provider First Name:
BILLY
Provider Middle Name:
VANCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, MHP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770798639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATKINSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30677-6004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-310-4096
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATKINSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30677-6004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-310-9046
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MSW004080 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CSW004465 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)