Provider Demographics
NPI:1477541126
Name:DONALD, CAMILLA (OD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLA
Middle Name:
Last Name:DONALD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CAMILLA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:270 COBB PKWY S
Mailing Address - Street 2:SUITE A-10A#264
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9320
Mailing Address - Country:US
Mailing Address - Phone:404-519-7567
Mailing Address - Fax:
Practice Address - Street 1:10600 DAVIS DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-4746
Practice Address - Country:US
Practice Address - Phone:770-992-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109625AMedicaid
MO95973Medicare UPIN