Healthcare Provider Details

I. General information

NPI: 1093825911
Provider Name (Legal Business Name): LAVONE E SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD SUITE 660
ATLANTA GA
30342-1626
US

IV. Provider business mailing address

980 JOHNSON FERRY RD SUITE 660
ATLANTA GA
30342-1626
US

V. Phone/Fax

Practice location:
  • Phone: 404-857-1580
  • Fax: 404-303-2015
Mailing address:
  • Phone: 404-857-1580
  • Fax: 404-303-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number72124
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60036782
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: