Provider Demographics
NPI:1659138428
Name:JAIME L. VIVAS, MD
Entity Type:Organization
Organization Name:JAIME L. VIVAS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRALLES VIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-660-1711
Mailing Address - Street 1:5605 PRINCETON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9069
Mailing Address - Country:US
Mailing Address - Phone:706-660-1711
Mailing Address - Fax:706-660-1713
Practice Address - Street 1:5605 PRINCETON AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9069
Practice Address - Country:US
Practice Address - Phone:706-660-1711
Practice Address - Fax:706-660-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty