Provider Demographics
NPI:1548497381
Name:SIMMONS, BENJAMIN FRANKLYN III (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:FRANKLYN
Last Name:SIMMONS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1106 REYNOLDS ST
Practice Address - Street 2:STE 100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4375
Practice Address - Country:US
Practice Address - Phone:704-289-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920616Medicaid
NC1548497381Medicaid
SCNC1635Medicaid
NCNC7851RMedicare PIN
NCNC7851CMedicare PIN
NCNC7851IMedicare PIN
NCNC7851NMedicare PIN
NCNC7851GMedicare PIN
NCNC7851PMedicare PIN
NCNC7851EMedicare PIN
NC1548497381Medicaid
NCNC7851LMedicare PIN
NCNC7851JMedicare PIN
NCNC7851OMedicare PIN
NC5920616Medicaid
SCNC1635Medicaid
NCNC7851DMedicare PIN
NCNC7851BMedicare PIN
NCNC7851HMedicare PIN
NCNC7851KMedicare PIN
NCNC7851AMedicare PIN