Provider Demographics
NPI:1215990809
Name:LIMA, MBUOMDA NASAH (PAAA)
Entity type:Individual
Prefix:
First Name:MBUOMDA
Middle Name:NASAH
Last Name:LIMA
Suffix:
Gender:F
Credentials:PAAA
Other - Prefix:
Other - First Name:NAMS
Other - Middle Name:
Other - Last Name:LIMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAAA
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-1002
Mailing Address - Country:US
Mailing Address - Phone:770-732-3649
Mailing Address - Fax:770-732-3648
Practice Address - Street 1:3950 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106
Practice Address - Country:US
Practice Address - Phone:770-732-3649
Practice Address - Fax:770-732-3648
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004639367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA205988194AMedicaid
Q54581Medicare UPIN
GA32BBBRXMedicare ID - Type Unspecified