MEDICARE: MICHAEL 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	225100000X	Physical Therapist	PT015275	GA
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1376126904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SIMMONS

Provider Business Mailing Address
First Line	:	6397 LEE HWY
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 HOWELL MILL RD NW STE B2
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-3117
Country	:	US
Telephone Number	:	404-351-5432
Fax Number	:

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

Provider Enumeration Date	:	05/02/2021
Last Update Date	:	03/01/2022

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