Healthcare Provider Details

I. General information

NPI: 1518891167
Provider Name (Legal Business Name): JOE SIMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WATERS DR
RALEIGH NC
27610-4838
US

IV. Provider business mailing address

2001 WATERS DR
RALEIGH NC
27610-4838
US

V. Phone/Fax

Practice location:
  • Phone: 919-272-5871
  • Fax:
Mailing address:
  • Phone: 919-272-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number9885109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: