Provider Demographics
NPI:1679212617
Name:ASGILL, SIMINI MILDRED
Entity type:Individual
Prefix:
First Name:SIMINI
Middle Name:MILDRED
Last Name:ASGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 HERITAGE CROSSING PT SW
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-9179
Mailing Address - Country:US
Mailing Address - Phone:678-571-1548
Mailing Address - Fax:
Practice Address - Street 1:4045 HERITAGE CROSSING PT SW
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-9179
Practice Address - Country:US
Practice Address - Phone:678-571-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-28
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN055273164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse