Healthcare Provider Details

I. General information

NPI: 1609109560
Provider Name (Legal Business Name): H. DAVID SIMMONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
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: DR. HAROLD DAVID SIMMONS
Title or Position: OWNER
Credential: M.D.
Phone: 662-226-0325