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NPI Code Detail

MEDICARE: A. LOUIS JIMENEZ, D.P.M., P.C.

MEDICARE: A. LOUIS JIMENEZ, D.P.M., P.C.
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
1261QA1903XAmbulatory Surgical Clinic/Center111126ASCAGA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GRP4587OTHERMEDICARE GROUP
2CM4891OTHERGARAILROAD MEDICARE PIN

General Provider Information

NPI Number : 1205910528
Entity Type Code : Organization
Provider Name (Legal Business Name) : A. LOUIS JIMENEZ, D.P.M., P.C.
Provider Business Mailing Address
First Line : 2175 NORTH RD
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2630
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 : ADMINISTRATOR/PHYSICIAN
Name : DR. A LOUIS JIMENEZ
Credential : DPM
Telephone Number : 770-979-0900
Provider Enumeration Date : 10/24/2006
Last Update Date : 12/17/2007

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