Healthcare Provider Details

I. General information

NPI: 1235238775
Provider Name (Legal Business Name): ESTEBAN LIM LIM JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CITY HALL DR
FORT OGLETHORPE GA
30742-7802
US

IV. Provider business mailing address

223 THORNCREST DR
RINGGOLD GA
30736-2677
US

V. Phone/Fax

Practice location:
  • Phone: 706-638-5584
  • Fax: 706-638-5585
Mailing address:
  • Phone: 706-638-5584
  • Fax: 706-638-5585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39394
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: