Provider Demographics
NPI:1689838146
Name:SIMS, STACY LATRICE (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:LATRICE
Last Name:SIMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:699 CHURCH STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1116
Mailing Address - Country:US
Mailing Address - Phone:770-422-8505
Mailing Address - Fax:770-424-7449
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1116
Practice Address - Country:US
Practice Address - Phone:770-422-8505
Practice Address - Fax:770-424-7449
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2017-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301092843207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127946AMedicaid
GA003127946BMedicaid
GA003127946AMedicaid