Healthcare Provider Details

I. General information

NPI: 1093078107
Provider Name (Legal Business Name): ANN SIMONIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 07/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 WATERS AVE STE 206
SAVANNAH GA
31404
US

IV. Provider business mailing address

4750 WATERS AVE STE 206
SAVANNAH GA
31404-6278
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-5915
  • Fax: 912-350-5930
Mailing address:
  • Phone: 912-350-5915
  • Fax: 912-350-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL34821
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number74912
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: