=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487680666
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIE ANITA MCCAMY-BLAKE RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1670 CLAIRMONT RD
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30033-4004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-321-6111
-----------------------------------------------------
Fax | 404-329-2238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3865 SPRINGLEAF CT
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30083-4692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-321-6111
-----------------------------------------------------
Fax | 404-329-2238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH015669
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------