MEDICARE: CAMILLE M BLYTHER CSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1013190388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE M BLYTHER CSA

Provider Business Mailing Address
First Line	:	6967 ROSWELL RD NE APT E
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-2337
Country	:	US
Telephone Number	:	404-484-7852
Fax Number	:

Provider Business Practice Location Address
First Line	:	6967 ROSWELL RD NE APT E
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-2337
Country	:	US
Telephone Number	:	404-484-7852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	03/14/2012

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