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General NPI Number Information
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NPI Number | 1235143884
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Entity Type | Organization
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Legal Business Name | CAMDEN WOMEN'S CENTER
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1351 EAST BOONE STREET SUITE 21
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City | KINGSLAND
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State | GA
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Zip | 31548
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Country | US
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Telephone | 912-727-5563
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Fax | 912-729-5564
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Provider Business Mailing Address
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Address Line | 1351 E. BOONE ST. STE 21
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City | KINGSLAND
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State | GA
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Zip | 31548
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Country | US
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Telephone | 912-727-5563
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Fax | 912-729-5564
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD L BRANDON
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Credential | M.D.
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Telephone | 912-729-5563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 14890
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License Number State | GA
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