Provider Demographics
NPI:1669527156
Name:LEMKE, JIMMY V (MD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:V
Last Name:LEMKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-774-7263
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:447 N BELAIR RD STE 104
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-854-2180
Practice Address - Fax:706-854-2189
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC016438207R00000X
GA32421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG32421Medicaid
110102923OtherRAILROAD MEDICARE
11D0687551OtherCLIA # FOR GROUP
GA00453032DMedicaid
SCE774967193Medicare PIN
GA00453032DMedicaid
E77496Medicare UPIN