Healthcare Provider Details

I. General information

NPI: 1710036686
Provider Name (Legal Business Name): AMY D IMES APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 PERIMETER CTR FL 11
ATLANTA GA
30338-5463
US

IV. Provider business mailing address

299 N HIGHLAND AVE NE UNIT 3038
ATLANTA GA
30307-5640
US

V. Phone/Fax

Practice location:
  • Phone: 404-220-7334
  • Fax:
Mailing address:
  • Phone: 478-244-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN139646
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number139646
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: