1922369636 NPI number — ASTOR T. LIM, MD, PC

Table of content: (NPI 1922369636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922369636 NPI number — ASTOR T. LIM, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASTOR T. LIM, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922369636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3226 HAMPTON AVE
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31520-4225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-265-2343
Provider Business Mailing Address Fax Number:
912-265-7792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3226 HAMPTON AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31520-4225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-265-2343
Provider Business Practice Location Address Fax Number:
912-265-7792
Provider Enumeration Date:
05/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LIM
Authorized Official First Name:
ASTOR
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
912-265-2343

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  018819 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00223022B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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