Healthcare Provider Details

I. General information

NPI: 1174396899
Provider Name (Legal Business Name): CAMELIA EADDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 KATHWOOD DR
ATHENS GA
30607-1132
US

IV. Provider business mailing address

1921 SEVER RD
LAWRENCEVILLE GA
30043-4015
US

V. Phone/Fax

Practice location:
  • Phone: 706-355-7400
  • Fax:
Mailing address:
  • Phone: 678-242-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN212698
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: