Provider Demographics
NPI:1851078398
Name:SIMMONS, CHVONNE
Entity Type:Individual
Prefix:
First Name:CHVONNE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MEMORIAL DR STE H
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1521
Mailing Address - Country:US
Mailing Address - Phone:225-375-5137
Mailing Address - Fax:864-336-2958
Practice Address - Street 1:310 MEMORIAL DR STE H
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1521
Practice Address - Country:US
Practice Address - Phone:225-375-5137
Practice Address - Fax:864-336-2958
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide