MEDICARE: DR. JOHN M ZIMMERMAN 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	MD152360	OR
2	207Q00000X	Family Medicine Physician	36304	SC
3	207Q00000X	Family Medicine Physician	070802	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180226	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1215078464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M ZIMMERMAN M.D.

Provider Business Mailing Address
First Line	:	109 MINIS AVE
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-2128
Country	:	US
Telephone Number	:	912-966-5445
Fax Number	:	912-966-5955

Provider Business Practice Location Address
First Line	:	109 MINIS AVE
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-2128
Country	:	US
Telephone Number	:	912-966-5445
Fax Number	:	912-966-5955

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/10/2015

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