Fred H Simonton III, D.M.D.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

10367 Issued in GA

Practice address

1221 Sherwood Park Dr NE Ste C
Gainesville, GA 30501-3404

Phone

(770) 531-1075

Fax

(770) 536-2815

NPI assigned

Aug 31, 2006

Last updated

Jan 29, 2019By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2014 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Atlanta Oral & Facial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1992738165
  NPD (past)
• Emory Medical Care Foundation Inc

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1063452381
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1578674271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 SHERWOOD PARK DR NE STE C",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013404",
            "telephone_number": "770-531-1075",
            "fax_number": "770-536-2815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 SHERWOOD PARK DR NE STE C",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013404",
            "telephone_number": "770-531-1075",
            "fax_number": "770-536-2815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONTON",
        "first_name": "FRED",
        "middle_name": "H",
        "name_suffix": "III",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "010367",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "GA",
            "license": "10367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000344462A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Taylor Simmons, DPT
• Emily P Simon, D.M.D.
• Karl Simon, PHARMD
• Katelyn Simon, DPT
• Jean Simone, MD
• Rebecca Ashley Simpson, AGACNP
• Vicki L Sims, PT
• Ansa Simson, BCABA
• Robyn Singer, AGACNP
• Abhishek Singh, MD

• Oral & Maxillofacial Surgery (D.M.D.) in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.