MEDICARE: DR. JAMES EARL SIMMONS M.D.

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	173000000X	Legal Medicine	21238	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21328	OTHER	SC	STATE LICENSE NUMBER
2	201242983	OTHER	SC	TAX ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750399242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EARL SIMMONS M.D.

Provider Business Mailing Address
First Line	:	1875 N PARIS AVE
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-2029
Country	:	US
Telephone Number	:	843-522-3870
Fax Number	:	843-522-0691

Provider Business Practice Location Address
First Line	:	1875 N PARIS AVE
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-2029
Country	:	US
Telephone Number	:	843-522-3870
Fax Number	:	843-522-0691

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/07/2023

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