Healthcare Provider Details

I. General information

NPI: 1992766943
Provider Name (Legal Business Name): EUGENE AINSWORTH SIMMONS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HIGHWAY 51 N
BROOKHAVEN MS
39601-2337
US

IV. Provider business mailing address

624 HIGHWAY 51 N
BROOKHAVEN MS
39601-2337
US

V. Phone/Fax

Practice location:
  • Phone: 601-823-3098
  • Fax: 601-823-3099
Mailing address:
  • Phone: 601-823-3098
  • Fax: 601-823-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17670
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: