Provider Demographics
NPI:1962689281
Name:SIMMONS, CHANTELLE MAIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANTELLE
Middle Name:MAIA
Last Name:SIMMONS
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 1:2004 RIDGEWOOD DR NE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2004 RIDGEWOOD DR NE
Practice Address - Street 2:SUITE 218
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1031
Practice Address - Country:US
Practice Address - Phone:404-727-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA595152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry