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NPI Code Detail

MEDICARE: JOHN SIMMS PA

MEDICARE: JOHN SIMMS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant001266GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114906849
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN SIMMS PA
Provider Business Mailing Address
First Line : PO BOX 657
Second Line :
City : DEMOREST
State : GA
Zip : 30535-0657
Country : US
Telephone Number : 706-865-4001
Fax Number : 706-865-6268
Provider Business Practice Location Address
First Line : 17 WHITE ST
Second Line :
City : CLEVELAND
State : GA
Zip : 30528-1140
Country : US
Telephone Number : 706-865-4001
Fax Number : 706-865-6268
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 11/29/2010

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Directions to “ JOHN SIMMS PA” Practice Location

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