Provider Demographics
NPI:1083098396
Name:CAMP, ANDREA DAVIS (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAVIS
Last Name:CAMP
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 LAKECREST WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-6043
Mailing Address - Country:US
Mailing Address - Phone:770-842-3848
Mailing Address - Fax:
Practice Address - Street 1:8805 LAKECREST WAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-6043
Practice Address - Country:US
Practice Address - Phone:770-842-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist