Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 000440 | GA |
NPI | 1023012929 |
---|---|
Provider Name | Dr. Angel Louis Jimenez |
First Address | Snellville, GA 30078-0527 |
Second Address | Snellville, GA 30078-2630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 22/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000157957A | (05) | GA |
480004616 | RAILROAD MEDICARE (01) | GA |
T97676 | (02) | GA |