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General NPI Number Information
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NPI Number | 1992125769
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Entity Type | Individual
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Provider Name | ALEXANDRA VICTORIA CAMP PA
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Gender | Female
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 1825 HIGHWAY 34 E SUITE 1200
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City | NEWNAN
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State | GA
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Zip | 30265-6423
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Country | US
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Telephone | 678-854-9914
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Fax |
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Provider Business Mailing Address
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Address Line | 300 ASHLEY PARK BLVD APT 215
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City | NEWNAN
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State | GA
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Zip | 30263-6353
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 7181
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License Number State | GA
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