Healthcare Provider Details

I. General information

NPI: 1780817536
Provider Name (Legal Business Name): CARLA J SIMMONS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MATHIS DR NW
ROME GA
30165-1242
US

IV. Provider business mailing address

1401 APPLEWOOD DR
DALTON GA
30720-2699
US

V. Phone/Fax

Practice location:
  • Phone: 706-295-6425
  • Fax: 706-295-6478
Mailing address:
  • Phone: 706-270-5002
  • Fax: 706-270-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN135451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: