Provider Demographics
NPI:1013322742
Name:A. LOUIS JIMENEZ D.P.M. PC
Entity Type:Organization
Organization Name:A. LOUIS JIMENEZ D.P.M. PC
Other - Org Name:PRIMERA FOOT & ANKLE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-979-0900
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-0527
Mailing Address - Country:US
Mailing Address - Phone:770-979-0900
Mailing Address - Fax:
Practice Address - Street 1:1150 HAMMOND DR BLDG E
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5334
Practice Address - Country:US
Practice Address - Phone:678-395-3628
Practice Address - Fax:678-691-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty