Individual
MIGUEL A JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3903 S COBB DR SE, SUITE 105, SMYRNA, GA 30080-6342
(678) 838-6600
(770) 438-1477
Mailing address
3280 POINTE PKWY STE 2550, NORCROSS, GA 30092-3473
(877) 877-7411
(877) 877-7411
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
52966
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52062173007
BCBS CARTERSVILLE ID
GA
01
—
52062173008
BCBS AUSTELL ID
GA
05
—
615972752A
—
GA
05
—
615972752B
—
GA
05
—
805775515A
—
GA
Enumeration date
07/11/2006
Last updated
10/31/2018
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