Provider Demographics
NPI:1376543736
Name:SIMMONS, DEBORAH A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 VERNON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4041
Mailing Address - Country:US
Mailing Address - Phone:706-812-9902
Mailing Address - Fax:
Practice Address - Street 1:1805 VERNON RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4041
Practice Address - Country:US
Practice Address - Phone:706-812-9902
Practice Address - Fax:706-812-0802
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028706207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000333198DMedicaid
GA000333198DMedicaid
GAD83828Medicare UPIN