Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD001017 | GA |
Y | 222Z00000X | Podiatrist | POD001017 | GA |
N | 213ES0103X | Foot & Ankle Surgery | POD001017 | GA |
NPI | 1083670673 |
---|---|
Provider Name | Margo Angela Jimenez |
First Address | Atlanta, GA 30339-3084 |
Second Address | Atlanta, GA 30345-2825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 19/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
690335867A | (05) | GA |
P00427170 | RAILROAD MEDICARE PTAN (01) | GA |
V09535 | (02) | GA |