Provider Demographics
NPI:1417923657
Name:JOHNSON, CAMERON CAMPBELL (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:CAMPBELL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 1201
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4550
Mailing Address - Country:US
Mailing Address - Phone:678-381-2020
Mailing Address - Fax:678-381-2015
Practice Address - Street 1:201 KIMBERLY WAY STE 106
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8009
Practice Address - Country:US
Practice Address - Phone:678-381-2020
Practice Address - Fax:678-381-2015
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93228207W00000X
GA067743207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272941500Medicaid
I37096Medicare UPIN
16073ZMedicare PIN
FL272941500Medicaid