Healthcare Provider Details

I. General information

NPI: 1831497619
Provider Name (Legal Business Name): CAMP CREEK WOMEN'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 CLEVELAND AVE SUITE 300
EAST POINT GA
30344-3618
US

IV. Provider business mailing address

3885 PRINCETON LAKES WAY SW SUITE 412
ATLANTA GA
30331-5589
US

V. Phone/Fax

Practice location:
  • Phone: 404-344-2229
  • Fax:
Mailing address:
  • Phone: 404-344-2229
  • Fax: 404-574-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number055205
License Number StateGA

VIII. Authorized Official

Name: DR. KEVIN J EDMONDS
Title or Position: OWNER/MEDICAL DIRECTOR
Credential:
Phone: 404-344-2229