Healthcare Provider Details

I. General information

NPI: 1356685390
Provider Name (Legal Business Name): CAMP CREEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 PRINCETON LAKES WAY SW STE 400
ATLANTA GA
30331-5589
US

IV. Provider business mailing address

1388A WELLBROOK CIR NE
CONYERS GA
30012-3872
US

V. Phone/Fax

Practice location:
  • Phone: 404-344-6575
  • Fax:
Mailing address:
  • Phone: 770-929-9033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. STEPHEN ROSENBAUM
Title or Position: CFO
Credential:
Phone: 404-920-4951