Provider Demographics
NPI:1386010403
Name:TERRELL, CAMILLA
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 CHAPEL HILL RD STE 800
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1712
Mailing Address - Country:US
Mailing Address - Phone:770-942-9931
Mailing Address - Fax:
Practice Address - Street 1:2750 CHAPEL HILL RD STE 800
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1712
Practice Address - Country:US
Practice Address - Phone:770-942-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist