Healthcare Provider Details

I. General information

NPI: 1568716207
Provider Name (Legal Business Name): CENTRAL ALABAMA PAIN MANAGEMENT CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 FOREST AVE
MONTGOMERY AL
36106-1543
US

IV. Provider business mailing address

1709 FOREST AVE
MONTGOMERY AL
36106-1543
US

V. Phone/Fax

Practice location:
  • Phone: 334-264-3367
  • Fax: 334-264-3305
Mailing address:
  • Phone: 334-264-3367
  • Fax: 334-264-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number15752
License Number StateAL

VIII. Authorized Official

Name: DR. ROGER WILLIAMS KEMP
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 334-264-3367