Organization
CHILDRENS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLYDE GRANVILLE SIMMONS M.D. (CEO)
(229) 528-4546
Entity
Organization
Contact information
Practice address
5488 N ALABAMA AVE, OMEGA, GA 31775-3054
(229) 528-4546
(229) 528-4841
Mailing address
PO BOX 7627, TIFTON, GA 31793-7627
(229) 396-5830
(229) 391-3686
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
12/21/2006
Last updated
03/26/2013
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