Simone Shardae Williams Moore, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

27978 Issued in MS

Practice address

702 Martin Luther King St
Mound Bayou, MS 38762-9314

Phone

(662) 741-8800

Fax

(662) 741-8925

NPI assigned

Jul 20, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Simone Shardae Williams Former name

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: simone.moore.p1@direct.deltahc.nextgenshare.com
• Direct secure messaging: iqc5772@yourcarecommunity.org

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

• Delta Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Mound Bayou, MS
  • NPI 1659378610
  Medicare reassignment NPD
• Delta Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Leland, MS
  • NPI 1598357378
  NPD
• Delta Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Greenville, MS
  • NPI 1215358783
  NPD
• Delta Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mayersville, MS
  • NPI 1689041063
  NPD (past)
• PHC-Cleveland LLC

  dba Bolivar Medical Center

  • General Acute Care Hospital
  • Cleveland, MS
  • NPI 1457321036
  NPD (past)

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

{
    "created_epoch": "1500508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1730602806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 MARTIN LUTHER KING ST",
            "city": "MOUND BAYOU",
            "state": "MS",
            "postal_code": "387629314",
            "telephone_number": "662-741-8902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 MARTIN LUTHER KING ST",
            "city": "MOUND BAYOU",
            "state": "MS",
            "postal_code": "387629314",
            "telephone_number": "662-741-8800",
            "fax_number": "662-741-8925"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-984-5200",
            "fax_number": "601-984-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SIMONE",
        "middle_name": "SHARDAE WILLIAMS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-20",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "27978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04501349",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIMONE",
            "last_name": "WILLIAMS",
            "middle_name": "SHARDAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Beverly C Johnson, MSW
• Carol Mack, LCSW
• Making Moves in the Community, Incorporated
• Drahea Martin, DDS
• Cordaro Mays, NREMT-P, ASCP
• Yolanda Monique Morton, NCC
• Mound Bayou Public School District
• Mound Bayou Public Schools (I T Montgomery Elementary School)
• Natural Pain Back Institute, LLC (Accutron Medical Wellness Testing Center)
• Nevaeh Hospice (Nevaeh Home Maker Service)

• Pediatrics Physician in Mound Bayou, MS
• Providers in Mound Bayou, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.