MEDICARE: MRS. COURTNEY CAMP HIGHSMITH DMD

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	1223G0001X	General Practice Dentistry	012829	GA

General Provider Information

NPI Number	:	1083749030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY CAMP HIGHSMITH DMD

Provider Business Mailing Address
First Line	:	3666 HIGHWAY 5 STE 102
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-6940
Country	:	US
Telephone Number	:	770-942-2852
Fax Number	:	770-942-3502

Provider Business Practice Location Address
First Line	:	3666 HIGHWAY 5 STE 102
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-6940
Country	:	US
Telephone Number	:	770-942-2852
Fax Number	:	770-942-3502

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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