Provider Demographics
NPI:1467553115
Name:SIMMONS, MILLICENT MURRAY (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MILLICENT
Middle Name:MURRAY
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 SAULSTON RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8526
Mailing Address - Country:US
Mailing Address - Phone:919-735-0139
Mailing Address - Fax:919-731-3394
Practice Address - Street 1:200 W ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3662
Practice Address - Country:US
Practice Address - Phone:919-735-0139
Practice Address - Fax:919-731-3394
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL00981133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered