Provider Demographics
NPI:1609824416
Name:SIMON, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:SIMON
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 1:2801 N DECATUR RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5949
Mailing Address - Country:US
Mailing Address - Phone:770-277-4277
Mailing Address - Fax:404-292-6305
Practice Address - Street 1:2801 N DECATUR RD
Practice Address - Street 2:SUITE 120
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5949
Practice Address - Country:US
Practice Address - Phone:770-277-4277
Practice Address - Fax:404-292-6305
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040846208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700465OtherUNITED HEALTHCARE
4608346001OtherCIGNA HMO
GA00947086AMedicaid
2969776OtherAETNA HMO
7375431OtherAETNA NON HMO
10556OtherKAISER
52439381OtherBCBS
4608346001OtherCIGNA HMO
GA00947086AMedicaid
GA00947086AMedicaid