Provider Demographics
NPI:1922369636
Name:ASTOR T. LIM, MD, PC
Entity Type:Organization
Organization Name:ASTOR T. LIM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASTOR
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-265-2343
Mailing Address - Street 1:3226 HAMPTON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4225
Mailing Address - Country:US
Mailing Address - Phone:912-265-2343
Mailing Address - Fax:912-265-7792
Practice Address - Street 1:3226 HAMPTON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4225
Practice Address - Country:US
Practice Address - Phone:912-265-2343
Practice Address - Fax:912-265-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00223022BMedicaid
GA00223022BMedicaid