Provider Demographics
NPI:1417942293
Name:SIMMONS, RICHARD S II (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:SIMMONS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 DOCTORS DRIVE
Mailing Address - Street 2:BUILDING 200
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4139
Mailing Address - Country:US
Mailing Address - Phone:706-884-3389
Mailing Address - Fax:706-880-7223
Practice Address - Street 1:1551 DOCTORS DRIVE
Practice Address - Street 2:BUILDING 200
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4139
Practice Address - Country:US
Practice Address - Phone:706-884-3389
Practice Address - Fax:706-880-7223
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28651207RS0012X, 207RP1001X, 174400000X
GA028651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00327533AMedicaid
GAC21821Medicare UPIN