MEDICARE: DR. CHARIS JEWELLE TRENCH-SIMMONS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	026079	LA
2	207V00000X	Obstetrics & Gynecology Physician	058337	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245490085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARIS JEWELLE TRENCH-SIMMONS M.D.

Provider Business Mailing Address
First Line	:	3885 PRINCETON LAKES WAY SW STE 412
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5599
Country	:	US
Telephone Number	:	678-365-2322
Fax Number	:	678-365-2333

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW
Second Line	:	SUITE 412
City	:	ATLANTA
State	:	GA
Zip	:	30331-5589
Country	:	US
Telephone Number	:	678-365-2322
Fax Number	:	678-365-2333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	05/18/2026

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Directions to “ DR. CHARIS JEWELLE TRENCH-SIMMONS M.D.” Practice Location

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