Healthcare Provider Details

I. General information

NPI: 1518877265
Provider Name (Legal Business Name): CAMERON DOUGLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 S MURPHREE ST
PITTSBORO MS
38951-9779
US

IV. Provider business mailing address

PO BOX 221
VARDAMAN MS
38878-0221
US

V. Phone/Fax

Practice location:
  • Phone: 662-989-4099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3463
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: