Provider Demographics
NPI:1164460655
Name:VANCAMP, KIPP ALLEN (DO)
Entity type:Individual
Prefix:DR
First Name:KIPP
Middle Name:ALLEN
Last Name:VANCAMP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3333 RIVERWOOD PKWY SE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3304
Mailing Address - Country:US
Mailing Address - Phone:770-914-0116
Mailing Address - Fax:770-955-4278
Practice Address - Street 1:604 LOVEJOY LN STE 100
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-3634
Practice Address - Country:US
Practice Address - Phone:770-268-4336
Practice Address - Fax:470-251-6063
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2025-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS05253112085R0202X
GA1035752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS106163OtherBCBS OF KS
KS104991OtherBCBS PROVIDER NUMBER
KSP00440177OtherRAILROAD MEDICARE GROUP DG5299
KS100234960FMedicaid
MO18484065OtherBCBS OF KANSAS CITY
KSP00477479OtherRR MEDICARE
KS1002234960HMedicaid
KSKA1066001OtherKS MEDICARE
KS106163OtherBCBS OF KS
KSP00477479OtherRR MEDICARE
KS1002234960HMedicaid
KS106163OtherBCBS OF KS