Provider Demographics
NPI:1235213919
Name:SIMMONS, SANDRA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JEAN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:228 MARKHAM DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2116
Mailing Address - Country:US
Mailing Address - Phone:919-942-9524
Mailing Address - Fax:919-664-7721
Practice Address - Street 1:567 E HARGETT ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1517
Practice Address - Country:US
Practice Address - Phone:919-856-5322
Practice Address - Fax:919-664-7721
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC94006382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG-100-47Medicare UPIN