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General NPI Number Information
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NPI Number | 1386209856
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Entity Type | Individual
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Provider Name | KA-LISHA MAE SIMONS MD
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Gender | Female
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1450 FERN CREEK DR
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City | STATESVILLE
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State | NC
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Zip | 28625-9376
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Country | US
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Telephone | 704-818-9191
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Fax | 704-872-3782
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Provider Business Mailing Address
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Address Line | 200 E 2ND AVE
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City | GASTONIA
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State | NC
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Zip | 28052-4358
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Country | US
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Telephone | 704-874-1900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA11444800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2024-00805
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License Number State | NC
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