Provider Demographics
NPI:1851634653
Name:SIMONS, DAVID WAYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:SIMONS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 EDGEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3205
Mailing Address - Country:US
Mailing Address - Phone:864-227-3908
Mailing Address - Fax:864-227-2668
Practice Address - Street 1:1033 EDGEFIELD ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3205
Practice Address - Country:US
Practice Address - Phone:864-227-3908
Practice Address - Fax:864-227-2668
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1704PAMedicaid
SC1704PAMedicaid