Provider Demographics
NPI:1497742704
Name:SIMMONS, HAROLD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:DAVID
Last Name:SIMMONS
Suffix:
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 1:340 VAN DORN ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4738
Mailing Address - Country:US
Mailing Address - Phone:662-226-0325
Mailing Address - Fax:662-226-0327
Practice Address - Street 1:340 VAN DORN ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4738
Practice Address - Country:US
Practice Address - Phone:662-226-0325
Practice Address - Fax:662-226-0327
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11777208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016473Medicaid
MS00016473Medicaid
MSD73582Medicare UPIN