Basic Information
| Provider Information | |||||||||
| NPI: | 1013971886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMONE | ||||||||
| FirstName: | DARRELL | ||||||||
| MiddleName: | NICHOLAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 CHURCH ST NE | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300607282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704199902 | ||||||||
| FaxNumber: | 7704197457 | ||||||||
| Practice Location | |||||||||
| Address1: | 5730 GLENRIDGE DR NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303286141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048163000 | ||||||||
| FaxNumber: | 6789045797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 08/31/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 045966 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1710946322 | 01 | GA | GROUP NPI NUMBER | OTHER | 000802018A | 05 | GA | MEDICAID | 1873942 | 01 | GA | CIGNA | OTHER |