MEDICARE: CRAIG A. CAMASTA DPM

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	213E00000X	Podiatrist	000676	GA

General Provider Information

NPI Number	:	1235131079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG A. CAMASTA DPM

Provider Business Mailing Address
First Line	:	1350 UPPER HEMBREE RD STE 100
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-0929
Country	:	US
Telephone Number	:	678-426-2171
Fax Number	:	404-446-1957

Provider Business Practice Location Address
First Line	:	5445 MERIDIAN MARK RD.
Second Line	:	STE. 390
City	:	ATLANTA
State	:	GA
Zip	:	30342-4755
Country	:	US
Telephone Number	:	404-237-3668
Fax Number	:	404-237-9563

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/14/2022

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