Simmons, Jack W

Simmons, Jack W is an individual health care provider with primary practice located at 2097 Henry Tecklenburg Dr Suite 312W, Charleston SC 29414-5740. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gynecology, which is considered as his primary health care specialty. Simmons, Jack W can be contacted via phone (843) 769-5620.

Contact Information

Primary practice address
2097 Henry Tecklenburg Dr Suite 312W Charleston SC 29414-5740
Fax: (843) 769-5625
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 10543 South Carolina

Profile Details

NPI number 1487625240
LBN Legal business name Simmons, Jack W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2006
Last updated Jan 4th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487625240 NPPES
South Carolina MEDICAID 105433
South Carolina Other CH6746

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