MEDICARE: DR. MOLLY R SIMS 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	208000000X	Pediatrics Physician	054512	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7454625	OTHER	GA	AETNA PPO

General Provider Information

NPI Number	:	1851383954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY R SIMS M.D.

Provider Business Mailing Address
First Line	:	3591 RIDGE AVE
Second Line	:	SUITE A
City	:	MACON
State	:	GA
Zip	:	31204-1875
Country	:	US
Telephone Number	:	478-475-1006
Fax Number	:	478-475-0787

Provider Business Practice Location Address
First Line	:	3591 RIDGE AVE
Second Line	:	SUITE A
City	:	MACON
State	:	GA
Zip	:	31204-1875
Country	:	US
Telephone Number	:	478-475-1006
Fax Number	:	478-475-0787

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/09/2007

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