Provider Demographics
NPI:1699281014
Name:KEMP, JEREMY CRAIG
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:CRAIG
Last Name:KEMP
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JEREMY
Other - Middle Name:CRAIG
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT/ATC
Mailing Address - Street 1:1292 MELTON DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1956
Mailing Address - Country:US
Mailing Address - Phone:404-702-5997
Mailing Address - Fax:
Practice Address - Street 1:1292 MELTON DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1956
Practice Address - Country:US
Practice Address - Phone:404-702-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20000214722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer