Healthcare Provider Details

I. General information

NPI: 1083636500
Provider Name (Legal Business Name): JESSICA N. SIMMONS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BRANDON AVE
CHARLOTTESVILLE VA
22903-3310
US

IV. Provider business mailing address

1307 ST GEORGE ST
CROZET VA
22932-3015
US

V. Phone/Fax

Practice location:
  • Phone: 434-982-3915
  • Fax: 434-982-0193
Mailing address:
  • Phone: 434-249-3581
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101239207
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: