Healthcare Provider Details

I. General information

NPI: 1528381126
Provider Name (Legal Business Name): ERICA S SIMMONS ALLIGOOD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2257 WEST ELM STREET SUITE A
WRIGHTSVILLE GA
31096
US

IV. Provider business mailing address

101 FAIRVIEW PARK DR
DUBLIN GA
31021-2501
US

V. Phone/Fax

Practice location:
  • Phone: 478-864-7967
  • Fax: 478-272-2616
Mailing address:
  • Phone: 478-272-7494
  • Fax: 478-272-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA001719
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: