Provider Demographics
NPI:1295780393
Name:JIMENEZ, ANDREA MERCEDES (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MERCEDES
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1709 LEGION RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2375
Mailing Address - Country:US
Mailing Address - Phone:919-913-4200
Mailing Address - Fax:919-913-4201
Practice Address - Street 1:412 CALDWELL EXT
Practice Address - Street 2:BUILDING 2
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-2065
Practice Address - Country:US
Practice Address - Phone:919-913-4200
Practice Address - Fax:919-913-4201
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC327412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945947Medicaid
NC8945947Medicaid
NCE29367Medicare UPIN