Provider Demographics
NPI:1174285308
Name:HANDLEY, CAMERON GLEN
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:GLEN
Last Name:HANDLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 TALUCAH RD
Mailing Address - Street 2:
Mailing Address - City:VALHERMOSO SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:35775
Mailing Address - Country:US
Mailing Address - Phone:256-777-4151
Mailing Address - Fax:
Practice Address - Street 1:470 TALUCAH RD
Practice Address - Street 2:
Practice Address - City:VALHERMOSO SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:35775
Practice Address - Country:US
Practice Address - Phone:256-777-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program