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NPI Code Detail

MEDICARE: DR. ANGEL LOUIS JIMENEZ D.P.M.

MEDICARE: DR. ANGEL LOUIS JIMENEZ D.P.M.
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
1213ES0103XFoot & Ankle Surgery Podiatrist000440GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1480004616OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023012929
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGEL LOUIS JIMENEZ D.P.M.
Provider Business Mailing Address
First Line : PO BOX 527
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-0527
Country : US
Telephone Number : 770-979-0900
Fax Number :
Provider Business Practice Location Address
First Line : 2175 NORTH RD
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2630
Country : US
Telephone Number : 770-979-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 09/22/2009

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