Healthcare Provider Details

I. General information

NPI: 1053058107
Provider Name (Legal Business Name): RACHEL LEONA SIMMONS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH ST STE 20
AUGUSTA GA
30901-2771
US

IV. Provider business mailing address

811 13TH ST STE 20
AUGUSTA GA
30901-2771
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-3401
  • Fax:
Mailing address:
  • Phone: 803-295-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP000782
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: