Provider Demographics
NPI:1598751281
Name:SIMMONS, EARNEST CALVIN (MD)
Entity Type:Individual
Prefix:
First Name:EARNEST
Middle Name:CALVIN
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 1:251 EISENHOWER DR.
Mailing Address - Street 2:APT #363
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-3612
Mailing Address - Country:US
Mailing Address - Phone:601-692-5671
Mailing Address - Fax:
Practice Address - Street 1:150 REYNOIR ST.
Practice Address - Street 2:ROOM 633
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530
Practice Address - Country:US
Practice Address - Phone:228-436-1633
Practice Address - Fax:404-436-1694
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAQ20352207Q00000X
MS19534208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000180925BMedicaid
GA01BDHTSMedicare ID - Type Unspecified
E72133Medicare UPIN
GA000180925BMedicaid