Provider Demographics
NPI:1346568631
Name:A. LOUIS JIMENEZ, DPM, PC
Entity Type:Organization
Organization Name:A. LOUIS JIMENEZ, DPM, PC
Other - Org Name:GWINNETT FOOT, ANKLE AND LEG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:A.
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-979-0900
Mailing Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5031
Mailing Address - Country:US
Mailing Address - Phone:770-670-6600
Mailing Address - Fax:770-670-6601
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5031
Practice Address - Country:US
Practice Address - Phone:770-670-6600
Practice Address - Fax:770-670-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0202370002Medicare NSC