Provider Demographics
NPI:1386745008
Name:SIMMONS, THOMAS CHARLES (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHARLES
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-0502
Mailing Address - Country:US
Mailing Address - Phone:478-934-3117
Mailing Address - Fax:478-934-3117
Practice Address - Street 1:1100 2ND ST SE
Practice Address - Street 2:MIDDLE GEORGIA COLLEGE
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-1564
Practice Address - Country:US
Practice Address - Phone:478-934-3117
Practice Address - Fax:478-934-3117
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0012452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer