Provider Demographics
NPI:1790834380
Name:SIMMONS, RONNIE LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:LEE
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2756
Mailing Address - Country:US
Mailing Address - Phone:770-364-0500
Mailing Address - Fax:770-720-0209
Practice Address - Street 1:270 E MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2756
Practice Address - Country:US
Practice Address - Phone:770-364-0500
Practice Address - Fax:770-720-0209
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001829103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist