Provider Demographics
NPI:1902187727
Name:SIMMONS, JAMES THOMAS (OTC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 RG SKINNER PARKWAY
Mailing Address - Street 2:SUITE 703
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-230-2000
Mailing Address - Fax:904-230-6000
Practice Address - Street 1:9191 RG SKINNER PARKWAY
Practice Address - Street 2:SUITE 703
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-230-2000
Practice Address - Fax:904-230-6000
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist