Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 20804 | GA |
NPI | 1194784744 |
---|---|
Provider Name | Dr. Jonathan Edward Reimer |
First Address | Evans, GA 30809-6034 |
Second Address | Augusta, GA 30909-6582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 07/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00201920C | (05) | GA |
D40952 | (02) | GA |