Provider Demographics
NPI:1174756464
Name:SIMPLY QUEENS INC
Entity type:Organization
Organization Name:SIMPLY QUEENS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP MARBARY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-395-3250
Mailing Address - Street 1:6974 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4427
Mailing Address - Country:US
Mailing Address - Phone:678-395-3250
Mailing Address - Fax:678-395-3252
Practice Address - Street 1:6974 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4427
Practice Address - Country:US
Practice Address - Phone:678-395-3250
Practice Address - Fax:678-395-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY-001519251B00000X, 305R00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA120066979AMedicare PIN