Provider Demographics
NPI:1396395570
Name:SIMMONS, KIZZY AUGUSTINE
Entity Type:Individual
Prefix:MRS
First Name:KIZZY
Middle Name:AUGUSTINE
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 1:6205 ABERCORN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5529
Mailing Address - Country:US
Mailing Address - Phone:912-525-2331
Mailing Address - Fax:912-428-5778
Practice Address - Street 1:6205 ABERCORN ST STE 111
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5529
Practice Address - Country:US
Practice Address - Phone:912-525-2331
Practice Address - Fax:912-428-5778
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
9815Other9815
GA9815Medicaid
GA9815OtherPHLEBOTOMISTS
9815OtherMOBILE PHLEBOTOMIST