Jon Preston Simmons, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

011278 Issued in GA

Practice address

205 W Orange St
Jesup, GA 31545-1701

Phone

(912) 427-2333

Fax

(912) 427-0898

NPI assigned

Sep 29, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1154318731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W ORANGE ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315451701",
            "telephone_number": "912-427-2333",
            "fax_number": "912-427-0898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W ORANGE ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315451701",
            "telephone_number": "912-427-2333",
            "fax_number": "912-427-0898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "JON",
        "middle_name": "PRESTON",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "011278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000667642A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "011278",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lawanda Brooke Smith
• Tandy M Smith, MSN, APRN, FNP-BC
• Thomas Glenn Smith, PT, DPT

• General Practice Dentistry in Jesup, GA
• Providers in Jesup, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.