Provider Demographics
NPI:1083670673
Name:JIMENEZ, MARGO ANGELA (DPM)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:ANGELA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 900
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:2295 PARKLAKE DR NE STE 150
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2825
Practice Address - Country:US
Practice Address - Phone:770-938-5974
Practice Address - Fax:770-939-4450
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001017213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00427170OtherRAILROAD MEDICARE PTAN
GA690335867AMedicaid
GA690335867AMedicaid
GAP00427170OtherRAILROAD MEDICARE PTAN
GA48SCCTVMedicare PIN