Provider Demographics
NPI:1154362481
Name:LIM, FRED T (MD)
Entity type:Individual
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First Name:FRED
Middle Name:T
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 C OLD MILTON PARKWAY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:770-663-8905
Practice Address - Street 1:3400 OLD MILTON PKWY # C
Practice Address - Street 2:SUITE 270
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:770-663-8905
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-01-06
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Provider Licenses
StateLicense IDTaxonomies
IL036110528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI20797Medicare UPIN