Healthcare Provider Details

I. General information

NPI: 1023457934
Provider Name (Legal Business Name): ERIKA SIMMERMAN MABES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA LANE SIMMERMAN DO

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST # OR6000
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3052
  • Fax: 706-721-7501
Mailing address:
  • Phone: 706-721-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number83419
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number006171
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number11020514A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number87542
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: