Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD60036782 | WA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 72124 | GA |
NPI | 1093825911 |
---|---|
Provider Name | Lavone E Simmons |
First Address | Atlanta, GA 30342-1626 |
Second Address | Atlanta, GA 30342-1626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 19/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0239553 | L&I (01) | WA |
1093825911 | (05) | WA |