Healthcare Provider Details

I. General information

NPI: 1275960239
Provider Name (Legal Business Name): CAMISHA MCCAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 OLD AIKEN RD
NORTH AUGUSTA SC
29841-9435
US

IV. Provider business mailing address

966 OLD AIKEN RD
NORTH AUGUSTA SC
29841-9435
US

V. Phone/Fax

Practice location:
  • Phone: 803-278-1567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA002778
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2577
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA4778
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: