Provider Demographics
NPI:1902842602
Name:SIMON, HEATHER L (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 CATHERINE VW
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:912-727-4183
Practice Address - Street 1:5 EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3345
Practice Address - Country:US
Practice Address - Phone:912-355-2400
Practice Address - Fax:912-355-5325
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053170207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA214057632CMedicaid
SCG53170Medicaid
GA214057632Medicaid
GA214057632FMedicaid
GA214057632AMedicaid
GA214057632EMedicaid
GA10058894OtherAMERIGROUP
GA214057632DMedicaid
GA214057632BMedicaid
GA10058894OtherAMERIGROUP
GA214057632CMedicaid
GA214057632FMedicaid