Provider Demographics
NPI:1245490085
Name:TRENCH-SIMMONS, CHARIS JEWELLE (MD)
Entity type:Individual
Prefix:DR
First Name:CHARIS
Middle Name:JEWELLE
Last Name:TRENCH-SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARIS
Other - Middle Name:JEWELLE
Other - Last Name:TRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3885 PRINCETON LAKES WAY SW
Mailing Address - Street 2:SUITE 412
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5589
Mailing Address - Country:US
Mailing Address - Phone:678-365-2322
Mailing Address - Fax:678-365-2333
Practice Address - Street 1:3885 PRINCETON LAKES WAY SW
Practice Address - Street 2:SUITE 412
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5589
Practice Address - Country:US
Practice Address - Phone:678-365-2322
Practice Address - Fax:678-365-2333
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058337207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA481312922AMedicaid
GA481312922BMedicaid
GA481312922CMedicaid
GA481312922BMedicaid