MEDICARE: DR. CAROL LYNN SIMMONS MD

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	14103	SC

General Provider Information

NPI Number	:	1972228229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL LYNN SIMMONS MD

Provider Business Mailing Address
First Line	:	2748 RUSH HAVEN DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8578
Country	:	US
Telephone Number	:	843-475-5989
Fax Number	:

Provider Business Practice Location Address
First Line	:	2748 RUSH HAVEN DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8578
Country	:	US
Telephone Number	:	843-475-5989
Fax Number	:

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

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/10/2022

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