Provider Demographics
NPI:1235301946
Name:LEDFORD, CAMILLE YORK (NP)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:YORK
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIVERSTONE VIS STE 300
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6683
Mailing Address - Country:US
Mailing Address - Phone:706-258-4178
Mailing Address - Fax:706-492-3206
Practice Address - Street 1:101 RIVERSTONE VIS STE 111
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6665
Practice Address - Country:US
Practice Address - Phone:706-946-4200
Practice Address - Fax:706-492-3206
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154445363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA367166824IMedicaid