1336770346 NPI number — MR. CAMERUN CHRISTOPHER WASHINGTON MS

Table of content: MR. CAMERUN CHRISTOPHER WASHINGTON MS (NPI 1336770346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336770346 NPI number — MR. CAMERUN CHRISTOPHER WASHINGTON MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHINGTON
Provider First Name:
CAMERUN
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
M

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:
1336770346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 GREGOR MENDEL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29646-2316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-941-8100
Provider Business Mailing Address Fax Number:
864-388-1052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 EDGEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29605-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-250-7944
Provider Business Practice Location Address Fax Number:
864-250-9582
Provider Enumeration Date:
01/29/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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