Provider Demographics
NPI:1447318134
Name:LATIMER, JIM WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:WAYNE
Last Name:LATIMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 REGENCY PARK DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7080
Mailing Address - Country:US
Mailing Address - Phone:770-957-4195
Mailing Address - Fax:770-898-6337
Practice Address - Street 1:101 REGENCY PARK DR
Practice Address - Street 2:SUITE 150
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7080
Practice Address - Country:US
Practice Address - Phone:770-957-4195
Practice Address - Fax:770-898-6337
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-10-13
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Provider Licenses
StateLicense IDTaxonomies
GA039391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA039391OtherSTATE LICENSE
GA039391OtherSTATE LICENSE
GAF61031Medicare UPIN