Provider Demographics
NPI:1093825911
Name:SIMMONS, LAVONE E
Entity Type:Individual
Prefix:
First Name:LAVONE
Middle Name:E
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 660
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:404-857-1580
Mailing Address - Fax:404-303-2015
Practice Address - Street 1:980 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 660
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-857-1580
Practice Address - Fax:404-303-2015
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72124207VM0101X
WAMD60036782207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093825911Medicaid
WA0239553OtherL&I
WA8875525Medicare PIN