Provider Demographics
NPI:1528381126
Name:SIMMONS ALLIGOOD, ERICA S (PTA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:S
Last Name:SIMMONS ALLIGOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FAIRVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2501
Mailing Address - Country:US
Mailing Address - Phone:478-272-7494
Mailing Address - Fax:478-272-2616
Practice Address - Street 1:2257 WEST ELM STREET
Practice Address - Street 2:SUITE A
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096
Practice Address - Country:US
Practice Address - Phone:478-864-7967
Practice Address - Fax:478-272-2616
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116544Medicare PIN