Healthcare Provider Details

I. General information

NPI: 1952620429
Provider Name (Legal Business Name): MATTHEW T SIMMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 SIXES RD SUITE 130
HOLLY SPRINGS GA
30115
US

IV. Provider business mailing address

684 SIXES RD. SUITE 130
HOLLY SPRINGS GA
30115
US

V. Phone/Fax

Practice location:
  • Phone: 770-517-6636
  • Fax: 770-517-6568
Mailing address:
  • Phone: 770-517-6636
  • Fax: 770-517-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number072688
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: