Provider Demographics
NPI:1164848602
Name:JIMADA, ISMAIL OPEYEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAIL
Middle Name:OPEYEMI
Last Name:JIMADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1450 E A ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2239
Mailing Address - Country:US
Mailing Address - Phone:307-234-8700
Mailing Address - Fax:307-234-8750
Practice Address - Street 1:11660 ALPHARETTA HWY STE 430
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3880
Practice Address - Country:US
Practice Address - Phone:770-255-1069
Practice Address - Fax:770-255-1075
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA96098207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty