Provider Demographics
NPI:1790754448
Name:KEMPH, CONSTANCE IANTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:IANTHA
Last Name:KEMPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CONSTANCE
Other - Middle Name:IANTHA
Other - Last Name:CRAUSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-1300
Mailing Address - Country:US
Mailing Address - Phone:205-591-5180
Mailing Address - Fax:205-551-0347
Practice Address - Street 1:601 WEST BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206-1300
Practice Address - Country:US
Practice Address - Phone:205-591-5180
Practice Address - Fax:205-551-0347
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00004563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL303719357Medicaid
ALG588OtherMEDICARE GROUP NUMBER
AL051510119OtherBLUE SHIELD
AL303719357Medicaid
ALG588OtherMEDICARE GROUP NUMBER