Provider Demographics
NPI:1386213130
Name:SIMMONS, LAYA ENZOR (FIRST ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LAYA
Middle Name:ENZOR
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FIRST ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FALLING TIMBER CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1181
Mailing Address - Country:US
Mailing Address - Phone:404-454-0022
Mailing Address - Fax:
Practice Address - Street 1:3180 N POINT PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4248
Practice Address - Country:US
Practice Address - Phone:770-559-8725
Practice Address - Fax:770-559-8276
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA195486363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical