Basic Information
| Provider Information | |||||||||
| NPI: | 1598751281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | EARNEST | ||||||||
| MiddleName: | CALVIN | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 EISENHOWER DR. | ||||||||
| Address2: | APT #363 | ||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395313612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016925671 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 REYNOIR ST. | ||||||||
| Address2: | ROOM 633 | ||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2284361633 | ||||||||
| FaxNumber: | 4044361694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Q20352 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 19534 | MS | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 000180925B | 05 | GA | MEDICAID |