| Willie Simmons | |
|
12500 Clearwater Way Upper Marlboro MD 20772-6600 | |
| (240) 432-9338 | |
| Not Available |
| Full Name | Willie Simmons |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 12500 Clearwater Way, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Willie A Simmons (MR.) |
| Authorized Official Contact | 2404329338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willie Simmons 12500 Clearwater Way Upper Marlboro MD 20772-6600 Ph: (240) 432-9338 | Willie Simmons 12500 Clearwater Way Upper Marlboro MD 20772-6600 Ph: (240) 432-9338 |
| NPI Number | 1699144402 |
|---|---|
| Provider Enumeration Date | 09/22/2015 |
| Last Update Date | 09/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699144402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LC50079182 (District Of Columbia) | Secondary |
| 251S00000X | Community/behavioral Health | 20930 (Maryland) | Primary |
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