Provider Demographics
NPI:1104832724
Name:SIMMONS, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
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 1:100 EAST CAHABA
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36748
Mailing Address - Country:US
Mailing Address - Phone:334-295-0170
Mailing Address - Fax:334-295-2275
Practice Address - Street 1:100 EAST CAHABA
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:AL
Practice Address - Zip Code:36748
Practice Address - Country:US
Practice Address - Phone:334-295-0170
Practice Address - Fax:334-295-2275
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL16795207P00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL117645Medicaid
AL117645Medicaid