Provider Demographics
NPI:1275858870
Name:CAMMACK CLINIC PA
Entity Type:Organization
Organization Name:CAMMACK CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:CAMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-936-9665
Mailing Address - Street 1:7552 NAVARRE PKWY UNIT 45
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7309
Mailing Address - Country:US
Mailing Address - Phone:850-936-9665
Mailing Address - Fax:
Practice Address - Street 1:7552 NAVARRE PKWY UNIT 45
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7309
Practice Address - Country:US
Practice Address - Phone:850-936-9665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0069924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty