Provider Demographics
NPI:1730366865
Name:SIMON, EDMUND LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:LLOYD
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 NORTHSIDE FORSYTH DR
Mailing Address - Street 2:STE 140
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6012
Mailing Address - Country:US
Mailing Address - Phone:770-292-7000
Mailing Address - Fax:770-292-7002
Practice Address - Street 1:1100 NORTHSIDE FORSYTH DR
Practice Address - Street 2:STE 140
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6012
Practice Address - Country:US
Practice Address - Phone:770-292-7000
Practice Address - Fax:770-292-7002
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2021-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA546702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA468024628MMedicaid
GA202I929966Medicare PIN