Provider Demographics
NPI:1922319599
Name:KIMBRELL, BART W (MD)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:W
Last Name:KIMBRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BART
Other - Middle Name:
Other - Last Name:KIMBRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:700 WILMINGTON ISLAND RD APT 503
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-4532
Mailing Address - Country:US
Mailing Address - Phone:770-540-5497
Mailing Address - Fax:
Practice Address - Street 1:200 W ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-282-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA669612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137778LMedicaid