Provider Demographics
NPI:1275138349
Name:GIM ENTERPRISES LLC
Entity Type:Organization
Organization Name:GIM ENTERPRISES LLC
Other - Org Name:FAMILY WELLNESS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGE-SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-707-4018
Mailing Address - Street 1:3371 N BERKELEY LAKE RD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:BERKELEY LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4367
Mailing Address - Country:US
Mailing Address - Phone:770-707-4018
Mailing Address - Fax:770-785-4488
Practice Address - Street 1:3625 SAVANNAH PL STE 101A
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6376
Practice Address - Country:US
Practice Address - Phone:770-707-4018
Practice Address - Fax:770-785-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174057335Medicaid
GA1689774382Medicaid
GA1083762025Medicaid