Healthcare Provider Details

I. General information

NPI: 1245228634
Provider Name (Legal Business Name): ROBERT WEBB SIMMONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 PROFESSIONAL BLVD
DALTON GA
30720-2588
US

IV. Provider business mailing address

1114 PROFESSIONAL BLVD
DALTON GA
30720-2588
US

V. Phone/Fax

Practice location:
  • Phone: 706-278-0138
  • Fax: 706-226-6882
Mailing address:
  • Phone: 706-278-0138
  • Fax: 706-226-6882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11476
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: