Healthcare Provider Details

I. General information

NPI: 1609824416
Provider Name (Legal Business Name): TIMOTHY SIMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N DECATUR RD SUITE 120
DECATUR GA
30033-5949
US

IV. Provider business mailing address

2801 N DECATUR RD SUITE 120
DECATUR GA
30033-5949
US

V. Phone/Fax

Practice location:
  • Phone: 770-277-4277
  • Fax: 404-292-6305
Mailing address:
  • Phone: 770-277-4277
  • Fax: 404-292-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number040846
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: