Healthcare Provider Details

I. General information

NPI: 1124012950
Provider Name (Legal Business Name): MATTHEW P RUPERT MD, MS, FIPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COVEY DR SUITE 103
FRANKLIN TN
37067-5665
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 615-550-8500
  • Fax: 615-550-8501
Mailing address:
  • Phone: 706-494-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number19037
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number42716
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: