Healthcare Provider Details

I. General information

NPI: 1912104266
Provider Name (Legal Business Name): NICHOLAS ALLEN KIMPEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SAINT CLAIR DRIVE
NEW MARKET AL
35761
US

IV. Provider business mailing address

460 SAINT CLAIR DRIVE
NEW MARKET AL
35761
US

V. Phone/Fax

Practice location:
  • Phone: 803-522-0953
  • Fax:
Mailing address:
  • Phone: 803-522-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberRTP002340
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number#DO1133
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number062130
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: