Healthcare Provider Details

I. General information

NPI: 1821613811
Provider Name (Legal Business Name): VICTORIA MARIE TIMMERMANS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2578 HELEN HWY
CLEVELAND GA
30528-2848
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-9100
  • Fax:
Mailing address:
  • Phone: 770-219-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95965
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: