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General NPI Number Information
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NPI Number | 1750566865
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Entity Type | Individual
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Provider Name | RUSSELL RYAN KEMPKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 905 SUMMIT POINTE WAY NE
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City | ATLANTA
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State | GA
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Zip | 30329-4062
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Country | US
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Telephone | 239-404-2398
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Fax |
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Provider Business Mailing Address
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Address Line | 905 SUMMIT POINTE WAY NE
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City | ATLANTA
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State | GA
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Zip | 30329-4062
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Country | US
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Telephone | 239-404-2398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 841478
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License Number State | GA
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