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General NPI Number Information
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NPI Number | 1659138428
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Entity Type | Organization
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Legal Business Name | JAIME L. VIVAS, MD
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 5605 PRINCETON AVE STE B
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City | COLUMBUS
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State | GA
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Zip | 31904-9069
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Country | US
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Telephone | 706-660-1711
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Fax | 706-660-1713
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Provider Business Mailing Address
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Address Line | 5605 PRINCETON AVE STE B
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City | COLUMBUS
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State | GA
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Zip | 31904-9069
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Country | US
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Telephone | 706-660-1711
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Fax | 706-660-1713
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | FE SERRALLES VIVAS
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Credential |
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Telephone | 706-660-1711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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