Healthcare Provider Details

I. General information

NPI: 1235131079
Provider Name (Legal Business Name): CRAIG A. CAMASTA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK RD. STE. 390
ATLANTA GA
30342-4755
US

IV. Provider business mailing address

1350 UPPER HEMBREE RD STE 100
ROSWELL GA
30076-0929
US

V. Phone/Fax

Practice location:
  • Phone: 404-237-3668
  • Fax: 404-237-9563
Mailing address:
  • Phone: 678-426-2171
  • Fax: 404-446-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: