Provider Demographics
NPI:1245237700
Name:IMES, ALLAN B JR (PA)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:B
Last Name:IMES
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 HIGHWAY 20 W
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7311
Mailing Address - Country:US
Mailing Address - Phone:770-288-2822
Mailing Address - Fax:770-692-8177
Practice Address - Street 1:1631 HIGHWAY 20 W
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7311
Practice Address - Country:US
Practice Address - Phone:770-288-2822
Practice Address - Fax:770-692-8177
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA238603985AMedicaid
GA238603985AMedicaid