Provider Demographics
NPI:1184783771
Name:SIMMONS, CINDY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12978 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752
Mailing Address - Country:US
Mailing Address - Phone:706-657-4183
Mailing Address - Fax:706-657-4270
Practice Address - Street 1:111 NORTH PINE STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752
Practice Address - Country:US
Practice Address - Phone:706-657-3360
Practice Address - Fax:706-657-4400
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2943363A00000X
TN1260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA181516355AMedicaid
GAQ34623Medicare UPIN
GA181516355AMedicaid