Provider Demographics
NPI:1487374914
Name:SIMPSON, TIFFANY NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:NICOLE
Other - Last Name:GREENWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3395 HYLAND DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-6006
Mailing Address - Country:US
Mailing Address - Phone:478-955-7684
Mailing Address - Fax:
Practice Address - Street 1:2395 WALL ST SE STE 176
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6703
Practice Address - Country:US
Practice Address - Phone:770-679-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist