Healthcare Provider Details

I. General information

NPI: 1710806930
Provider Name (Legal Business Name): MISS ABIGAIL LYDIA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 ROSS CLARK CIR STE 2
DOTHAN AL
36301-4746
US

IV. Provider business mailing address

492 MALVERN RD
DOTHAN AL
36301-7204
US

V. Phone/Fax

Practice location:
  • Phone: 334-446-4283
  • Fax: 334-446-4886
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: