Provider Demographics
NPI:1093989519
Name:SIMMONS, VIVIAN OLSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:OLSEN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:169 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36344-1219
Mailing Address - Country:US
Mailing Address - Phone:334-588-0804
Mailing Address - Fax:334-588-0492
Practice Address - Street 1:169 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:AL
Practice Address - Zip Code:36344-1219
Practice Address - Country:US
Practice Address - Phone:334-588-0804
Practice Address - Fax:334-588-0492
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.34777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine