Individual
SCOTTY SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
320 CICADA DR SE, MILLEDGEVILLE, GA 31061-5941
(912) 424-4467
Mailing address
320 CICADA DR SE, MILLEDGEVILLE, GA 31061-5941
(912) 424-4467
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
GA
Enumeration date
09/03/2020
Last updated
08/10/2021
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