Healthcare Provider Details

I. General information

NPI: 1649204751
Provider Name (Legal Business Name): MIGUEL A JIMENEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 S COBB DR SE SUITE 105
SMYRNA GA
30080-6342
US

IV. Provider business mailing address

3280 POINTE PKWY STE 2550
NORCROSS GA
30092-3473
US

V. Phone/Fax

Practice location:
  • Phone: 678-838-6600
  • Fax: 770-438-1477
Mailing address:
  • Phone: 877-877-7411
  • Fax: 877-877-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number52966
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: