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General NPI Number Information
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NPI Number | 1376996702
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Entity Type | Individual
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Provider Name | CHRISTINE CAROL JIMINEZ PA
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Gender | Female
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 901 RICE ST NW
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City | ATLANTA
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State | GA
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Zip | 30318-4938
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Country | US
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Telephone | 404-613-2022
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Fax | 404-893-6641
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Provider Business Mailing Address
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Address Line | 304 FAIRDALE TRCE
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7784
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Country | US
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Telephone | 678-856-9526
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002894
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License Number State | GA
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