Provider Demographics
NPI:1679712194
Name:SIMMS, GODFREY SAMUEL (PT ASSISTANT)
Entity Type:Individual
Prefix:
First Name:GODFREY
Middle Name:SAMUEL
Last Name:SIMMS
Suffix:
Gender:M
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 BLACK SHOALS RD NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-1901
Mailing Address - Country:US
Mailing Address - Phone:404-455-4554
Mailing Address - Fax:770-760-9767
Practice Address - Street 1:2729 BLACK SHOALS RD NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-1901
Practice Address - Country:US
Practice Address - Phone:404-455-4554
Practice Address - Fax:770-760-9767
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001983225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant