Provider Demographics
NPI:1316238330
Name:SIMMONS, THOMAS WORTHAM JR (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WORTHAM
Last Name:SIMMONS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 VIOLET AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-1825
Mailing Address - Country:US
Mailing Address - Phone:678-233-7311
Mailing Address - Fax:770-477-7035
Practice Address - Street 1:833 FOREST PKWY
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2210
Practice Address - Country:US
Practice Address - Phone:404-366-8420
Practice Address - Fax:404-361-7765
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist