Healthcare Provider Details

I. General information

NPI: 1184783771
Provider Name (Legal Business Name): CINDY MARIE SIMMONS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NORTH PINE STREET
TRENTON GA
30752
US

IV. Provider business mailing address

12978 N. MAIN STREET
TRENTON GA
30752
US

V. Phone/Fax

Practice location:
  • Phone: 706-657-3360
  • Fax: 706-657-4400
Mailing address:
  • Phone: 706-657-4183
  • Fax: 706-657-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2943
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1260
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: