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NPI Code Detail

MEDICARE: CAMEL CITY REHABILITATION MEDICINE PLLC

MEDICARE: CAMEL CITY REHABILITATION MEDICINE PLLC
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
1208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1659948404
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAMEL CITY REHABILITATION MEDICINE PLLC
Provider Business Mailing Address
First Line : 905 SHADOWMERE CT
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27104-5023
Country : US
Telephone Number : 336-403-0686
Fax Number : 336-754-3895
Provider Business Practice Location Address
First Line : 2475 HILLCREST CENTER CIR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-3048
Country : US
Telephone Number : 336-754-3605
Fax Number : 336-754-3895
Authorized Official
Title or Position : OWNER
Name : DR. JAMES MARTIN MCLEAN
Credential : MD
Telephone Number : 336-403-0686
Provider Enumeration Date : 06/09/2021
Last Update Date : 06/09/2021

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