Healthcare Provider Details

I. General information

NPI: 1679754212
Provider Name (Legal Business Name): AMANI FRANKLIN HEMPHILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MADDEX DR
SHEPHERDSTOWN WV
25443
US

IV. Provider business mailing address

4470 BLACK IRONWOOD DR
FAIRFAX VA
22030-9068
US

V. Phone/Fax

Practice location:
  • Phone: 304-876-9422
  • Fax: 304-876-6869
Mailing address:
  • Phone: 443-803-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101260886
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD600004429
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD71417
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number26356
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: