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General NPI Number Information
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NPI Number | 1861503906
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Entity Type | Organization
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Legal Business Name | CAMP CREEK PRIMARY CARE, PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3890 REDWINE RD SW SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30331-5509
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Country | US
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Telephone | 404-349-2273
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Fax | 404-349-1511
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Provider Business Mailing Address
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Address Line | PO BOX 90237
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City | EAST POINT
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State | GA
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Zip | 30364-0237
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Country | US
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Telephone | 404-349-2273
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Fax | 404-349-1511
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Authorized Official
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Title or Position | CFO/ BUSINESS MANAGER
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Name | MS. LISA B. GREEN-CLOPTON
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Credential | JD
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Telephone | 404-349-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 043019
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License Number State | GA
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