1306904537 NPI number — LAURA ROHNERT SIMMONS P.T.

Table of content: LAURA ROHNERT SIMMONS P.T. (NPI 1306904537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306904537 NPI number — LAURA ROHNERT SIMMONS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMONS
Provider First Name:
LAURA
Provider Middle Name:
ROHNERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROHNERT
Provider Other First Name:
LAURA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306904537
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1194 MANCHESTER WAY NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKHAVEN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30319-4713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-491-0323
Provider Business Mailing Address Fax Number:
404-738-1433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1194 MANCHESTER WAY NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKHAVEN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30319-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-491-0323
Provider Business Practice Location Address Fax Number:
404-738-1433
Provider Enumeration Date:
12/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , with the licence number: 011282 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 34102 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)