Provider Demographics
NPI:1942825450
Name:JIMENEZ CORDERO, ENOE J
Entity type:Individual
Prefix:
First Name:ENOE
Middle Name:J
Last Name:JIMENEZ CORDERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ENOE
Other - Middle Name:J
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1120 15TH ST # BI-2144
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-7753
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST # BI-2144
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11960207L00000X
ARE-19101207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology