Provider Demographics
NPI:1245328624
Name:EMBRY, KENNETH E III (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:EMBRY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2859 VAN LEER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133
Mailing Address - Country:US
Mailing Address - Phone:901-751-5513
Mailing Address - Fax:901-751-5540
Practice Address - Street 1:3091 KIRBY WHITTEN PKWY
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-752-6963
Practice Address - Fax:901-759-4704
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172962083P0500X, 208D00000X
TN24112208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C68429Medicare UPIN
KYC68429Medicare UPIN