MEDICARE: DR. CAMILLE FRANCES STANBACK M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	D0096748	MD
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	9360	GA
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD210002366	DC
4	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	83490	GA
5	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1386056372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMILLE FRANCES STANBACK M.D.

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-0000
Fax Number	:	410-500-4266

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE STE 1950
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2247
Country	:	US
Telephone Number	:	404-778-3280
Fax Number	:

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

Provider Enumeration Date	:	05/23/2014
Last Update Date	:	12/10/2025

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