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General NPI Number Information
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NPI Number | 1922269612
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Entity Type | Organization
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Legal Business Name | CAMP CREEK PEDIATRICS LLC
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 06/24/2008
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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 | 30331-5582
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Country | US
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Telephone | 404-349-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 HIGHWAY 85 N SUITE 310-246
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4035
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Country | US
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Telephone | 404-349-2273
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHARLENE JOHNSON-BROWN
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Credential |
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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 | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 049655
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License Number State | GA
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