Healthcare Provider Details

I. General information

NPI: 1013900604
Provider Name (Legal Business Name): JOHN ALEXANDER LIMBURG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 WELLNESS WAY SUITE 130
ST. SIMONS ISLAND GA
31522
US

IV. Provider business mailing address

7000 WELLNESS WAY SUITE 130
ST. SIMONS ISLAND GA
31522
US

V. Phone/Fax

Practice location:
  • Phone: 912-638-4855
  • Fax: 912-638-8302
Mailing address:
  • Phone: 912-638-4855
  • Fax: 912-638-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56735
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27921
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38631
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: