Provider Demographics
NPI:1437113917
Name:CAMP, MATTHEW W (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:CAMP
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 1:150 INTERSTATE SOUTH DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143
Mailing Address - Country:US
Mailing Address - Phone:706-253-2267
Mailing Address - Fax:678-454-7331
Practice Address - Street 1:150 INTERSTATE SOUTH DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:706-253-2267
Practice Address - Fax:678-454-7331
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040828207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000781569AMedicaid
GA000781569AMedicaid
GA00965Medicare PIN
GAG66446Medicare UPIN
GAC30849Medicare PIN