1831497619 NPI number — CAMP CREEK WOMEN'S HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831497619 NPI number — CAMP CREEK WOMEN'S HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMP CREEK WOMEN'S HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831497619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3885 PRINCETON LAKES WAY SW
Provider Second Line Business Mailing Address:
SUITE 412
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30331-5589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-344-2229
Provider Business Mailing Address Fax Number:
404-574-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1136 CLEVELAND AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-3618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-344-2229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
EDMONDS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
404-344-2229

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  055205 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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