Provider Demographics
NPI:1013900604
Name:LIMBURG, JOHN ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:LIMBURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7000 WELLNESS WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ST. SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522
Mailing Address - Country:US
Mailing Address - Phone:912-638-4855
Mailing Address - Fax:912-638-8302
Practice Address - Street 1:7000 WELLNESS WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:ST. SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522
Practice Address - Country:US
Practice Address - Phone:912-638-4855
Practice Address - Fax:912-638-8302
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA56735207Q00000X
SC27921207Q00000X
TN38631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
129428Medicare UPIN