Healthcare Provider Details

I. General information

NPI: 1386213130
Provider Name (Legal Business Name): LAYA ENZOR SIMMONS FIRST ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 N POINT PKWY
ALPHARETTA GA
30005-4248
US

IV. Provider business mailing address

304 FALLING TIMBER CT
STOCKBRIDGE GA
30281-1181
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-8725
  • Fax: 770-559-8276
Mailing address:
  • Phone: 404-454-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number195486
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: