Provider Demographics
NPI:1407054810
Name:A. LOUIS JIMENEZ, DPM, PC
Entity Type:Organization
Organization Name:A. LOUIS JIMENEZ, DPM, PC
Other - Org Name:PRIMERA FOOT & ANKLE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DORIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-979-0900
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-0527
Mailing Address - Country:US
Mailing Address - Phone:770-979-0900
Mailing Address - Fax:770-979-2852
Practice Address - Street 1:2220 WISTERIA DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-4604
Practice Address - Country:US
Practice Address - Phone:770-979-0900
Practice Address - Fax:770-979-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000440213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000157957AMedicaid
GACM4891OtherRAILROAD MEDICARE
GA000157957AMedicaid
GAT97676Medicare UPIN
GAGRP4587Medicare PIN