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NPI Code Detail

MEDICARE: ALLAN B IMES JR. P.A.

MEDICARE: ALLAN B IMES JR. P.A.
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
1363A00000XPhysician Assistant004088GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245237700
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLAN B IMES JR. P.A.
Provider Business Mailing Address
First Line : 1631 HIGHWAY 20 W
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-7311
Country : US
Telephone Number : 770-288-2822
Fax Number : 770-692-8177
Provider Business Practice Location Address
First Line : 1631 HIGHWAY 20 W
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-7311
Country : US
Telephone Number : 770-288-2822
Fax Number : 770-692-8177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 10/15/2015

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