Provider Demographics
NPI:1912941147
Name:SIMMONS, JORY STEVEN SR (MD, MSPH)
Entity Type:Individual
Prefix:
First Name:JORY
Middle Name:STEVEN
Last Name:SIMMONS
Suffix:SR
Gender:M
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 BELL RIDGE TRCE
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2006
Mailing Address - Country:US
Mailing Address - Phone:615-399-7947
Mailing Address - Fax:615-399-7947
Practice Address - Street 1:1203A MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37012
Practice Address - Country:US
Practice Address - Phone:615-895-4855
Practice Address - Fax:615-895-8939
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD162612083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001239Medicare UPIN
TN3370244Medicare PIN