Basic Information
Provider Information | |||||||||
NPI: | 1831127521 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KEMP | ||||||||
FirstName: | CARLTON | ||||||||
MiddleName: | R. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4700 WATERS AVE STE 507 | ||||||||
Address2: |   | ||||||||
City: | SAVANNAH | ||||||||
State: | GA | ||||||||
PostalCode: | 314046220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9123504750 | ||||||||
FaxNumber: | 9123504751 | ||||||||
Practice Location | |||||||||
Address1: | 4700 WATERS AVE STE 507 | ||||||||
Address2: |   | ||||||||
City: | SAVANNAH | ||||||||
State: | GA | ||||||||
PostalCode: | 314046220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9123504750 | ||||||||
FaxNumber: | 9123504751 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/29/2006 | ||||||||
LastUpdateDate: | 09/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 046870 | GA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | ME 100245 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | ME 100245 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | ME 100245 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RS0012X | 046870 | GA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | 046870 | GA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | 879204 | 01 | GA | BLUE CROSS BLUE SHIELD | OTHER | 582162071002 | 01 |   | CHAMPUS | OTHER | 50026 | 01 | FL | BCBS | OTHER | G46870 | 05 | SC |   | MEDICAID | P00053217 | 01 |   | RAILROAD MEDICARE | OTHER | 352352957A | 05 | GA |   | MEDICAID |