Provider Demographics
NPI:1013971886
Name:SIMONE, DARRELL NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:NICHOLAS
Last Name:SIMONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CHURCH ST NE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7282
Mailing Address - Country:US
Mailing Address - Phone:770-419-9902
Mailing Address - Fax:770-419-7457
Practice Address - Street 1:5730 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-6141
Practice Address - Country:US
Practice Address - Phone:404-816-3000
Practice Address - Fax:678-904-5797
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045966207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1710946322OtherGROUP NPI NUMBER
GA000802018AMedicaid
GA1873942OtherCIGNA
GA000802018AMedicaid
GA05BDGJPMedicare PIN
GA050060460Medicare PIN