=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053688135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHAB DOC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2011
-----------------------------------------------------
Last Update Date | 03/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3379 PEACHTREE RD NE SUITE 555
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30326-1031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-682-0767
-----------------------------------------------------
Fax | 888-650-8387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3379 PEACHTREE RD NE SUITE 555
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30326-1031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-682-0767
-----------------------------------------------------
Fax | 404-682-0766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KIMBERLY D GILBERT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 404-445-9799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 62848
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------