Provider Demographics
NPI:1295613040
Name:SIMMONS, AZARIA
Entity type:Individual
Prefix:
First Name:AZARIA
Middle Name:
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 1:821 KING GEORGE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8329
Mailing Address - Country:US
Mailing Address - Phone:386-213-3087
Mailing Address - Fax:
Practice Address - Street 1:821 KING GEORGE BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-8329
Practice Address - Country:US
Practice Address - Phone:386-213-3087
Practice Address - Fax:386-213-3087
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy