Provider Demographics
NPI:1518047844
Name:HIGHTOWER, JIMMY L JR (PAC)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:L
Last Name:HIGHTOWER
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3758 HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3653
Mailing Address - Country:US
Mailing Address - Phone:678-561-9430
Mailing Address - Fax:770-914-1070
Practice Address - Street 1:3758 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248
Practice Address - Country:US
Practice Address - Phone:678-561-9430
Practice Address - Fax:770-914-1070
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA4949363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant