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General NPI Number Information
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NPI Number | 1972885192
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Entity Type | Individual
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Provider Name | KATHARINE REGINA SIMMONS PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 1349 MILSTEAD RD NE
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City | CONYERS
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State | GA
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Zip | 30012-3871
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Country | US
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Telephone | 770-785-7546
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Fax | 770-761-8521
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Provider Business Mailing Address
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Address Line | 2400 BELLEVUE RD STE 21A
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City | DUBLIN
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State | GA
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Zip | 31021-2890
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Country | US
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Telephone | 478-328-0281
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Fax | 478-328-0438
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4266
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License Number State | GA
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