Provider Demographics
NPI:1902836000
Name:BROWN-GULLATT, KIMBERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:BROWN-GULLATT
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 1:1600 FORT BENNING RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-2834
Mailing Address - Country:US
Mailing Address - Phone:706-322-9599
Mailing Address - Fax:706-322-9567
Practice Address - Street 1:1600 FORT BENNING RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903-2834
Practice Address - Country:US
Practice Address - Phone:706-322-9599
Practice Address - Fax:706-322-9567
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107162EMedicaid
GA202I087834OtherMEDICARE PTAN
GA202I087834OtherMEDICARE PTAN