MEDICARE: ALEXIS SIMMONS

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1164122024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS SIMMONS

Provider Business Mailing Address
First Line	:	3086 EASTBROOK TER SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5471
Country	:	US
Telephone Number	:	404-539-6127
Fax Number	:

Provider Business Practice Location Address
First Line	:	3086 EASTBROOK TER SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5471
Country	:	US
Telephone Number	:	404-539-6127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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Directions to “ ALEXIS SIMMONS ” Practice Location

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