Provider Demographics
NPI:1972885192
Name:SIMMONS, KATHARINE REGINA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:REGINA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:2400 BELLEVUE RD STE 21A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2890
Mailing Address - Country:US
Mailing Address - Phone:478-328-0281
Mailing Address - Fax:478-328-0438
Practice Address - Street 1:1349 MILSTEAD RD NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3871
Practice Address - Country:US
Practice Address - Phone:770-785-7546
Practice Address - Fax:770-761-8521
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2021-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA4266363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003171361AMedicaid