Innovativemdgroup

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

052966 Issued in GA

Legal business name

INNOVATIVEMDGROUP

Practice address

3903 South Cobb
Suite 105
Smyrna, GA 30080-6370

Phone

(678) 838-6600

Fax

(770) 438-1477

NPI assigned

Aug 12, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andres Jimenez, M.D.

Title

Ceo

Phone

(678) 838-6600

Specialties & licenses 2

Addresses

Other names 1

• drmajimenez. Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316736000000",
    "number": "1609155357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3390 PEACHTREE RD NE",
            "address_2": "SUITE 450",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303261157",
            "telephone_number": "678-838-6600",
            "fax_number": "770-438-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 SOUTH COBB",
            "address_2": "SUITE 105",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300806370",
            "telephone_number": "678-838-6600",
            "fax_number": "770-438-1477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVEMDGROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-12",
        "last_updated": "2011-09-23",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "ANDRES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-838-6600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "GA",
            "license": "052966",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "GA",
            "license": "065573",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "drmajimenez.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Orthopaedic Surgery of the Spine Physician in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Orthopaedic Surgery of the Spine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.