Healthcare Provider Details

I. General information

NPI: 1376451252
Provider Name (Legal Business Name): KENNYA SIMMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 SPRING GARDEN DR SW
ATLANTA GA
30315-7209
US

IV. Provider business mailing address

2421 SPRING GARDEN DR SW
ATLANTA GA
30315-7209
US

V. Phone/Fax

Practice location:
  • Phone: 678-517-3332
  • Fax:
Mailing address:
  • Phone: 678-517-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT015076
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: