Provider Demographics
NPI:1578624011
Name:CHARLES K. EMBRY, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:CHARLES K. EMBRY, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:EMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-765-2503
Mailing Address - Street 1:107 N MANTLE AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2453
Mailing Address - Country:US
Mailing Address - Phone:270-765-2503
Mailing Address - Fax:
Practice Address - Street 1:107 N MANTLE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2453
Practice Address - Country:US
Practice Address - Phone:270-765-2503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty