Provider Demographics
NPI:1376996702
Name:JIMINEZ, CHRISTINE CAROL (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CAROL
Last Name:JIMINEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FAIRDALE TRCE
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7784
Mailing Address - Country:US
Mailing Address - Phone:678-856-9526
Mailing Address - Fax:
Practice Address - Street 1:901 RICE ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4938
Practice Address - Country:US
Practice Address - Phone:404-613-2022
Practice Address - Fax:404-893-6641
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002894363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical