Individual
DR. JACK W SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2097 HENRY TECKLENBURG DR, SUITE 312W, CHARLESTON, SC 29414-5740
(843) 769-5620
(843) 769-5625
Mailing address
2097 HENRY TECKLENBURG DR, SUITE 312W, CHARLESTON, SC 29414-5740
(843) 769-5620
(843) 769-5625
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
10543
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105433
—
SC
01
—
CH6746
RAILROAD MEDICARE
SC
Enumeration date
01/30/2006
Last updated
01/04/2013
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