Provider Demographics
NPI:1841690393
Name:A. LOUIS JIMENEZ DPM PC
Entity type:Organization
Organization Name:A. LOUIS JIMENEZ DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2175 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2630
Mailing Address - Country:US
Mailing Address - Phone:770-979-0900
Mailing Address - Fax:770-979-2852
Practice Address - Street 1:6610 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-3524
Practice Address - Country:US
Practice Address - Phone:770-497-1017
Practice Address - Fax:770-497-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty