Provider Demographics
NPI:1609454271
Name:JIMENEZ RUBIO, JEFFENY
Entity Type:Individual
Prefix:
First Name:JEFFENY
Middle Name:
Last Name:JIMENEZ RUBIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 OAKMOOR CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2364
Mailing Address - Country:US
Mailing Address - Phone:678-907-5237
Mailing Address - Fax:
Practice Address - Street 1:4961 BUFORD HWY STE 201
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3536
Practice Address - Country:US
Practice Address - Phone:470-509-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262513163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse