Provider Demographics
NPI:1194784744
Name:REIMER, JONATHAN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:EDWARD
Last Name:REIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-6034
Mailing Address - Country:US
Mailing Address - Phone:706-831-8421
Mailing Address - Fax:
Practice Address - Street 1:1224 AUGUSTA WEST PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6582
Practice Address - Country:US
Practice Address - Phone:706-860-2986
Practice Address - Fax:706-863-8129
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20804207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00201920CMedicaid
GAD40952Medicare UPIN