Provider Demographics
NPI:1851598676
Name:JONATHAN E REIMER MD,PC
Entity Type:Organization
Organization Name:JONATHAN E REIMER MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:706-860-2986
Mailing Address - Street 1:1224 AUGUSTA WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6582
Mailing Address - Country:US
Mailing Address - Phone:706-860-2986
Mailing Address - Fax:706-863-8129
Practice Address - Street 1:1224 AUGUSTA WEST PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6582
Practice Address - Country:US
Practice Address - Phone:706-860-2986
Practice Address - Fax:706-863-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20804207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00201902CMedicaid
GA00201902CMedicaid
GA538489537BMedicare ID - Type Unspecified