MEDICARE: DR. CAMERON CALDWELL KERSEY M.D.

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	2085R0202X	Diagnostic Radiology Physician	00025498	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00882624	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902933229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMERON CALDWELL KERSEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-0370
Country	:	US
Telephone Number	:
Fax Number	:	706-494-3008

Provider Business Practice Location Address
First Line	:	717 20TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8920
Country	:	US
Telephone Number	:	706-653-0292
Fax Number	:	706-653-1230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	06/04/2020

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