Healthcare Provider Details

I. General information

NPI: 1164493375
Provider Name (Legal Business Name): EDWARD DAVID SIMMER M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BULL ST
COLUMBIA SC
29201-2104
US

IV. Provider business mailing address

PO BOX 1257
BEAUFORT SC
29901-1257
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-0124
  • Fax:
Mailing address:
  • Phone: 757-334-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number0101047358
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number85866
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number85866
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: