Provider Demographics
NPI:1952666299
Name:SIMMONS, MARIA O
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:O
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 1:636 FOREST RIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7155
Mailing Address - Country:US
Mailing Address - Phone:770-977-6866
Mailing Address - Fax:770-783-8639
Practice Address - Street 1:790 OAK TRAIL DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-7502
Practice Address - Country:US
Practice Address - Phone:770-977-6866
Practice Address - Fax:770-783-8639
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator