Individual
LIA SIMPSON ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
648 EAST MONMOUTH STREET, WINSTON SALEM, NC 27107
(336) 718-4630
(336) 718-4369
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 718-4360
(336) 718-4369
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
200601245
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5905225
—
NC
01
—
TL-850
CO TRAINING LICENSE
—
Enumeration date
09/25/2006
Last updated
10/28/2020
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