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General NPI Number Information
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NPI Number | 1164848602
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Entity Type | Individual
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Provider Name | ISMAIL OPEYEMI JIMADA MD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 11660 ALPHARETTA HWY STE 430
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City | ROSWELL
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State | GA
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Zip | 30076-3880
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Country | US
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Telephone | 770-255-1069
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Fax | 770-255-1075
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Provider Business Mailing Address
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Address Line | 1450 E A ST STE 1
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City | CASPER
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State | WY
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Zip | 82601-2239
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Country | US
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Telephone | 307-234-8700
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Fax | 307-234-8750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 3271759
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 96098
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License Number State | GA
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