Provider Demographics
NPI:1013190388
Name:BLYTHER, CAMILLE M (CSA)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:M
Last Name:BLYTHER
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6967 ROSWELL RD NE APT E
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2337
Mailing Address - Country:US
Mailing Address - Phone:404-484-7852
Mailing Address - Fax:
Practice Address - Street 1:6967 ROSWELL RD NE APT E
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2337
Practice Address - Country:US
Practice Address - Phone:404-484-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant