Provider Demographics
NPI:1740262864
Name:KIMMERLING, ERICK ANDERSON (DO)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:ANDERSON
Last Name:KIMMERLING
Suffix:
Gender:M
Credentials:DO
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 1587
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1587
Mailing Address - Country:US
Mailing Address - Phone:706-226-1530
Mailing Address - Fax:833-731-0539
Practice Address - Street 1:1411 CHATTANOOGA AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2673
Practice Address - Country:US
Practice Address - Phone:706-226-1530
Practice Address - Fax:706-277-4215
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29196207RS0012X
GA029196207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000458906DMedicaid
GA290005663OtherRAILROAD MEDICARE
GA000458906DMedicaid
GA29BDBQZMedicare ID - Type UnspecifiedMEDICARE