Provider Demographics
NPI:1316183197
Name:JIMENEZ, GRISEL ENERIS (MD)
Entity Type:Individual
Prefix:
First Name:GRISEL
Middle Name:ENERIS
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRISEL
Other - Middle Name:ENERIS
Other - Last Name:JIMENEZ-FAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11807 NORTHFALL LN STE 901
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7972
Mailing Address - Country:US
Mailing Address - Phone:678-913-8209
Mailing Address - Fax:678-461-0019
Practice Address - Street 1:11807 NORTHFALL LN STE 901
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7972
Practice Address - Country:US
Practice Address - Phone:678-913-8209
Practice Address - Fax:678-461-0019
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0391382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry