Provider Demographics
NPI:1164678215
Name:CAMERON, CHARLE' L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHARLE'
Middle Name:L
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2045 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1414
Mailing Address - Country:US
Mailing Address - Phone:404-351-7546
Mailing Address - Fax:404-352-4706
Practice Address - Street 1:2045 PEACHTREE RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1414
Practice Address - Country:US
Practice Address - Phone:404-351-7546
Practice Address - Fax:404-352-4706
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant