MEDICARE: DR. RICHARD FREEMAN SIMMONS DDS

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	122300000X	Dentist	7805	GA

General Provider Information

NPI Number	:	1578756565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD FREEMAN SIMMONS DDS

Provider Business Mailing Address
First Line	:	2219 B WEST POINT RD
Second Line	:	RICHARD F SIMMONS DDS
City	:	LAGRANGE
State	:	GA
Zip	:	30241
Country	:	US
Telephone Number	:	706-883-7173
Fax Number	:	706-884-6865

Provider Business Practice Location Address
First Line	:	2219 B WEST POINT RD
Second Line	:	DR RICHARD F SIMMONS
City	:	LAGRANGE
State	:	GA
Zip	:	30241
Country	:	US
Telephone Number	:	706-883-7173
Fax Number	:	706-884-6865

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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