Provider Demographics
NPI:1265944805
Name:SIMMONS, KARMON M (LMT)
Entity type:Individual
Prefix:
First Name:KARMON
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7285 MERLIN WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1564
Mailing Address - Country:US
Mailing Address - Phone:202-702-1101
Mailing Address - Fax:
Practice Address - Street 1:90 COMMERCE DR STE C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7519
Practice Address - Country:US
Practice Address - Phone:678-519-2036
Practice Address - Fax:678-519-2036
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010908225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist