Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 3008275 | SC |
NPI | 1164999744 |
---|---|
Provider Name | Mr. Joseph Simmons JR. |
First Address | Sumter, SC 29153-8336 |
Second Address | Sumter, SC 29153-8336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2018 |
Last Update Date | 31/10/2018 |