Provider Demographics
NPI:1346708849
Name:SIMMS, DEBRA IMANI
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:IMANI
Last Name:SIMMS
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 1:2301 BUTTERNUT CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-8400
Mailing Address - Country:US
Mailing Address - Phone:832-205-7896
Mailing Address - Fax:
Practice Address - Street 1:519 PLEASANT HOME RD STE A1
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0545
Practice Address - Country:US
Practice Address - Phone:832-205-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO126891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist