Basic Information
| Provider Information | |||||||||
| NPI: | 1659397982 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMS | ||||||||
| FirstName: | GRETA | ||||||||
| MiddleName: | FAY | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 QUILLEN DR | ||||||||
| Address2: | |||||||||
| City: | GATE CITY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242513318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763862572 | ||||||||
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| Practice Location | |||||||||
| Address1: | 404 REVERE ST | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376603671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232464600 | ||||||||
| FaxNumber: | 4232463311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 0000002127 | TN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 3077628 | 01 | TN | BLUECROSS BLUESHIELD | OTHER |