Individual
WANEICE SIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
106 CORPORATE DR STE C, CARROLLTON, GA 30117-2493
(678) 739-1740
Mailing address
PO BOX 2652, CARROLLTON, GA 30112-0049
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
022R1898
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003224122A
—
GA
Enumeration date
01/29/2021
Last updated
01/29/2021
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