Most Relevant Information
Provider Data
| NPI Number: | 1003308594 |
| Provider Name: | PATRINA JIMMERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 171W00000X |
| Specialty: | Contractor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/31/2018 |
| Last Updated: | 05/31/2018 |
Provider Practice Location
212 LESLIE HWY
LEESBURG
GA
317634337
Practice Location Phone/Fax
| Phone: | 2296030259 |
| Fax: |
Provider Mailing Location
212 LESLIE HWY
LEESBURG
GA
317634337
Provider Mailing Phone/Fax
| Phone: | 2296030259 |
| Fax: |