Provider Demographics
NPI:1801993563
Name:SIMMONS, STEPHEN PIERCE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PIERCE
Last Name:SIMMONS
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 1:1707 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3517
Mailing Address - Country:US
Mailing Address - Phone:931-381-4932
Mailing Address - Fax:931-380-9216
Practice Address - Street 1:1707 GROVE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3517
Practice Address - Country:US
Practice Address - Phone:931-381-4932
Practice Address - Fax:931-380-9216
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3163519Medicaid
TN3163519Medicaid
TN3163519Medicare ID - Type Unspecified