Provider Demographics
NPI:1164999744
Name:SIMMONS, JOSEPH JR
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:SIMMONS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W BREWINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-8336
Mailing Address - Country:US
Mailing Address - Phone:803-494-9581
Mailing Address - Fax:803-494-9587
Practice Address - Street 1:3300 W BREWINGTON RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-8336
Practice Address - Country:US
Practice Address - Phone:803-494-9581
Practice Address - Fax:803-494-9587
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3008275207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services