Healthcare Provider Details

I. General information

NPI: 1477997062
Provider Name (Legal Business Name): JENNIFER A ZIMMERMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 FAIR RD
STATESBORO GA
30458-1683
US

IV. Provider business mailing address

1499 FAIR RD
STATESBORO GA
30458-1683
US

V. Phone/Fax

Practice location:
  • Phone: 304-424-2111
  • Fax:
Mailing address:
  • Phone: 912-486-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number078870
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: