Provider Demographics
NPI:1548251010
Name:JAMIESON, TIMOTHY A (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:JAMIESON
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 1:2500 STARLING ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-466-5100
Mailing Address - Fax:912-466-5113
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-466-5100
Practice Address - Fax:912-466-5113
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 810432085R0001X
GA0458402085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274882OtherAVMED
FL58555OtherBCBS
GAP00212741OtherMEDICARE RAILROAD
GA000834886CMedicaid
FL273598900Medicaid
GA92BBFVQMedicare PIN
FL58555OtherBCBS
FL58555MMedicare PIN
FL58555IMedicare PIN
FLG98384Medicare UPIN
FL58555LMedicare PIN
FL274882OtherAVMED
FL58555OMedicare PIN
FL58555HMedicare PIN
GA000834886CMedicaid
FL58555JMedicare PIN
FL58555NMedicare PIN