Provider Demographics
NPI:1598788655
Name:WALPERT, KIMBERLY P (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:P
Last Name:WALPERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 KING AVENUE
Mailing Address - Street 2:MSB SECOND FLOOR
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-1685
Mailing Address - Country:US
Mailing Address - Phone:706-475-1870
Mailing Address - Fax:
Practice Address - Street 1:242 KING AVENUE
Practice Address - Street 2:MSB SECOND FLOOR
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1685
Practice Address - Country:US
Practice Address - Phone:706-475-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049153207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00883176AMedicaid
GAH42967Medicare UPIN
GA00883176AMedicaid