Provider Demographics
NPI:1326419649
Name:KIMBERLY WALPERT, M.D., LLC
Entity Type:Organization
Organization Name:KIMBERLY WALPERT, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REV CYCLE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-369-5472
Mailing Address - Street 1:PO BOX 161435
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30321-1435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:MEDICAL SERVICES BLDG, SECOND FLOOR
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-369-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049153207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty