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General NPI Number Information
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NPI Number | 1386524437
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Entity Type | Organization
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Legal Business Name | PHYSICAL LIFE LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 850 HAMPTON RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-6514
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Country | US
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Telephone | 678-272-0464
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Fax |
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Provider Business Mailing Address
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Address Line | 191 BARCLAY DR
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City | MCDONOUGH
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State | GA
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Zip | 30252-8035
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Country | US
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Telephone | 678-272-0464
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Fax | 678-272-0862
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Authorized Official
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Title or Position | OWNER
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Name | DR. TREVINO SIMMONS
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Credential | DNP, FNP
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Telephone | 770-380-9756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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