Provider Demographics
NPI:1124012950
Name:RUPERT, MATTHEW P (MD, MS, FIPP)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:P
Last Name:RUPERT
Suffix:
Gender:
Credentials:MD, MS, FIPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:706-494-3171
Mailing Address - Fax:
Practice Address - Street 1:100 COVEY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5665
Practice Address - Country:US
Practice Address - Phone:615-550-8500
Practice Address - Fax:615-550-8501
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19037208VP0014X
TN42716208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS720000019Medicare ID - Type Unspecified
MSI35403Medicare UPIN