Provider Demographics
NPI:1255415071
Name:SIMMONS, ROBERT SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:SIMMONS
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2197
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-2197
Mailing Address - Country:US
Mailing Address - Phone:229-388-9339
Mailing Address - Fax:229-388-9339
Practice Address - Street 1:215 4TH ST E STE A
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4421
Practice Address - Country:US
Practice Address - Phone:229-388-9339
Practice Address - Fax:229-388-9339
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6732111N00000X
GACHIROO6565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU65545Medicare UPIN
GA35ZCFXHMedicare ID - Type UnspecifiedMEDICARE NUMBER