Basic Information
| Provider Information | |||||||||
| NPI: | 1780652719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ROSS | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 HEALTH PARK DR | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153737600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5570 COUGAR TRAIL RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | DUBLIN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240843849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579552828 | ||||||||
| FaxNumber: | 7579552829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 52301 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0102201994 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1780652719 | 05 | VA | MEDICAID |