Individual
MATTHEW J GIMPERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
745 POPLAR ROAD, NEWNAN, GA 32605-1618
(770) 400-1000
Mailing address
745 POPLAR ROAD, NEWNAN, GA 30265-1618
(770) 400-1000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-114640
IL
207R00000X
Internal Medicine Physician
036-114640
IL
2085R0202X
Diagnostic Radiology Physician
Primary
068165
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008232173
BLUECROSS BLUESHIELD
IL
05
—
003125660H
—
GA
01
—
08232205
BLUE CROSS BLUE SHIELD
IL
01
—
P00351066
RAILROAD MEDICARE
IL
01
—
P01064321
RAILROAD MEDICARE
GA
Enumeration date
08/03/2006
Last updated
03/03/2016
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