MEDICARE: DR. JOHN ALEXANDER LIMBURG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	56735	GA
2	207Q00000X	Family Medicine Physician	27921	SC
3	207Q00000X	Family Medicine Physician	38631	TN

General Provider Information

NPI Number	:	1013900604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALEXANDER LIMBURG M.D.

Provider Business Mailing Address
First Line	:	7000 WELLNESS WAY
Second Line	:	SUITE 130
City	:	ST. SIMONS ISLAND
State	:	GA
Zip	:	31522
Country	:	US
Telephone Number	:	912-638-4855
Fax Number	:	912-638-8302

Provider Business Practice Location Address
First Line	:	7000 WELLNESS WAY
Second Line	:	SUITE 130
City	:	ST. SIMONS ISLAND
State	:	GA
Zip	:	31522
Country	:	US
Telephone Number	:	912-638-4855
Fax Number	:	912-638-8302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	09/10/2014

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