Doctor Name: | CLYDE G SIMMONS |
NPI Number: | 1235193582 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 17301 |
Business Practice Address: | 5488 N Alabama Ave Omega, GA - 317753054 |
Business Phone Number: | 2295284546 |
Business Fax Number: | 2295284841 |
Mailing Address: | Po Box 7627, TIFTON |
State: | GA |
Postal Code: | 317937627 |
Phone Number: | 2293965830 |
Fax Number: | 2293913686 |
NPI Enumeration Date: | 04/13/2006 |
NPI Last Update Date: | 03/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 17301 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |