Healthcare Provider Details

I. General information

NPI: 1184803116
Provider Name (Legal Business Name): RICHARD F. CAMINO GAZTAMBIDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 SAINT SEBASTIAN WAY
AUGUSTA GA
30912-2613
US

IV. Provider business mailing address

1499 WALTON WAY STE 1400 ATTN: D. RAIFORD
AUGUSTA GA
30901-2603
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-6597
  • Fax: 706-721-6602
Mailing address:
  • Phone: 706-828-8401
  • Fax: 706-722-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number070352
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: