Provider Demographics
NPI:1215923149
Name:PIMENTEL, JUAN LUIS JR (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:LUIS
Last Name:PIMENTEL
Suffix:JR
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 1:1000 COWLES CLINIC WAY STE CY300
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-5285
Mailing Address - Country:US
Mailing Address - Phone:706-410-2111
Mailing Address - Fax:770-981-0208
Practice Address - Street 1:1000 COWLES CLINIC WAY STE CY-300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642
Practice Address - Country:US
Practice Address - Phone:706-410-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031547207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000702281GMedicaid
GA390006879OtherMEDICARE RAILROAD
GAGRP2709Medicare PIN
GA39BDBXGMedicare ID - Type Unspecified
GA000702281GMedicaid