Individual
MR. GLEN DALE SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1803 N JACKSON ST, TULLAHOMA, TN 37388-2201
(931) 461-1324
(931) 461-1304
Mailing address
402 SHERWOOD DR, TULLAHOMA, TN 37388-2162
(931) 455-5269
(931) 455-5269
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/03/2007
Last updated
07/08/2007
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