MEDICARE: CAMP CREEK WOMEN'S HEALTH SPECIALIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	55205	GA

General Provider Information

NPI Number	:	1255354122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMP CREEK WOMEN'S HEALTH SPECIALIST

Provider Business Mailing Address
First Line	:	3890 REDWINE RD SW STE 106
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5509
Country	:	US
Telephone Number	:	404-344-2229
Fax Number	:	404-574-6715

Provider Business Practice Location Address
First Line	:	3890 REDWINE RD SW STE 106
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5509
Country	:	US
Telephone Number	:	404-344-2229
Fax Number	:	404-574-6715

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/ CEO
Name	:	DR. KEVIN JERMAINE EDMONDS
Credential	:	M.D.
Telephone Number	:	404-344-2229

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/22/2020

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