Healthcare Provider Details

I. General information

NPI: 1144124397
Provider Name (Legal Business Name): MR. TREVIN L SIMMONS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST
MACON GA
31201-2102
US

IV. Provider business mailing address

3257 CLAIRMONT AVE
MACON GA
31204-1012
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-6750
  • Fax:
Mailing address:
  • Phone: 912-381-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number8057
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: