Healthcare Provider Details

I. General information

NPI: 1497742704
Provider Name (Legal Business Name): HAROLD DAVID SIMMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 VAN DORN ST
GRENADA MS
38901-4738
US

IV. Provider business mailing address

340 VAN DORN ST
GRENADA MS
38901-4738
US

V. Phone/Fax

Practice location:
  • Phone: 662-226-0325
  • Fax: 662-226-0327
Mailing address:
  • Phone: 662-226-0325
  • Fax: 662-226-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11777
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: