Provider Demographics
NPI:1346839289
Name:CAMACK, DAMIAN L
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:L
Last Name:CAMACK
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 1:10 CREEKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5862
Mailing Address - Country:US
Mailing Address - Phone:336-392-8093
Mailing Address - Fax:
Practice Address - Street 1:10 CREEKSTONE CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5862
Practice Address - Country:US
Practice Address - Phone:336-392-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No372600000XNursing Service Related ProvidersAdult Companion