MEDICARE: ESTEBAN LIM LIM JR. 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	2084P0800X	Psychiatry Physician	39394	GA

General Provider Information

NPI Number	:	1235238775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTEBAN LIM LIM JR. M.D.

Provider Business Mailing Address
First Line	:	223 THORNCREST DR
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-2677
Country	:	US
Telephone Number	:	706-638-5584
Fax Number	:	706-638-5585

Provider Business Practice Location Address
First Line	:	700 CITY HALL DR
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-7802
Country	:	US
Telephone Number	:	706-638-5584
Fax Number	:	706-638-5585

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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