Healthcare Provider Details

I. General information

NPI: 1720449010
Provider Name (Legal Business Name): JUDITH CAMERON MAGUIRE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH CAMERON CHAMBERS

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 MEDICAL PLAZA LN
SOUTHPORT NC
28461-5194
US

IV. Provider business mailing address

924 N HOWE ST
SOUTHPORT NC
28461-3038
US

V. Phone/Fax

Practice location:
  • Phone: 910-457-3800
  • Fax:
Mailing address:
  • Phone: 910-457-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06175
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-06175
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: