Provider Demographics
NPI:1891714887
Name:LIM, ASTOR T (MD, PC)
Entity Type:Individual
Prefix:
First Name:ASTOR
Middle Name:T
Last Name:LIM
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 HAMPTON AVE STE E
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4255
Mailing Address - Country:US
Mailing Address - Phone:912-265-2343
Mailing Address - Fax:
Practice Address - Street 1:3226 HAMPTON AVE STE E
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4255
Practice Address - Country:US
Practice Address - Phone:912-265-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00223022BMedicaid
GA00223022BMedicaid