=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083636500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA N. SIMMONS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 07/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 BRANDON AVE
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22903-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-982-3915
-----------------------------------------------------
Fax | 434-982-0193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1307 ST GEORGE ST
-----------------------------------------------------
City | CROZET
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22932-3015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-249-3581
-----------------------------------------------------
Fax | 434-972-4266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 0101239207
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------