Provider Demographics
NPI:1891372298
Name:JIMERSON, NICOLE PRITCHETT (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PRITCHETT
Last Name:JIMERSON
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 RIVERWOOD PKWY SE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3304
Mailing Address - Country:US
Mailing Address - Phone:770-914-0116
Mailing Address - Fax:
Practice Address - Street 1:1502 W 3RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1979
Practice Address - Country:US
Practice Address - Phone:678-774-0430
Practice Address - Fax:770-775-3410
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine