Healthcare Provider Details

I. General information

NPI: 1952802555
Provider Name (Legal Business Name): AIM HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 SAINT MARYS VIEW RD
ACCOKEEK MD
20607-3765
US

IV. Provider business mailing address

29 JACKS CT
RICHMOND HILL GA
31324-9344
US

V. Phone/Fax

Practice location:
  • Phone: 336-740-0897
  • Fax:
Mailing address:
  • Phone: 336-740-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR127999
License Number StateMD

VIII. Authorized Official

Name: JEAN WILSON
Title or Position: OWNER
Credential: NP
Phone: 336-740-0897