MEDICARE: SULTAN JABARI SIMMS 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	2084P0800X	Psychiatry Physician	055975	GA

General Provider Information

NPI Number	:	1851330310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SULTAN JABARI SIMMS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 44281
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30336-1281
Country	:	US
Telephone Number	:	404-861-4085
Fax Number	:	770-969-4337

Provider Business Practice Location Address
First Line	:	3455 N DESERT DR
Second Line	:	BUILDING 3, SUITE 106
City	:	EAST POINT
State	:	GA
Zip	:	30344-5725
Country	:	US
Telephone Number	:	404-768-4600
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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