Provider Demographics
NPI:1285707596
Name:SIMMONS IV, JOHN W (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:SIMMONS IV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2381 MAIN ST E STE B
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3358
Mailing Address - Country:US
Mailing Address - Phone:770-985-2437
Mailing Address - Fax:770-817-2400
Practice Address - Street 1:2381 MAIN ST E STE B
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3358
Practice Address - Country:US
Practice Address - Phone:770-985-2437
Practice Address - Fax:770-817-2400
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice