Provider Demographics
NPI:1972602357
Name:PALMER, TIMOTHY JAKE (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAKE
Last Name:PALMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 JACKSON ST STE B
Mailing Address - Street 2:PO BOX 766
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3159
Mailing Address - Country:US
Mailing Address - Phone:478-289-0007
Mailing Address - Fax:478-289-0067
Practice Address - Street 1:120 JACKSON ST STE B
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3159
Practice Address - Country:US
Practice Address - Phone:478-289-0007
Practice Address - Fax:478-289-0067
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000151258KMedicaid
GAD40796Medicare UPIN
GA000151258KMedicaid