Provider Demographics
NPI:1386208767
Name:CAMMOCK, ETHELIN CAMILLE (MD)
Entity Type:Individual
Prefix:MISS
First Name:ETHELIN
Middle Name:CAMILLE
Last Name:CAMMOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NANZETTA WAY
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-7102
Mailing Address - Country:US
Mailing Address - Phone:605-660-4360
Mailing Address - Fax:
Practice Address - Street 1:115 NANZETTA WAY
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-7102
Practice Address - Country:US
Practice Address - Phone:605-660-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-02051207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology