Provider Demographics
NPI:1497710834
Name:CAMERON, TRICIA M (MD)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:M
Last Name:CAMERON
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 1:1053 LAKEBEND DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-9783
Mailing Address - Country:US
Mailing Address - Phone:770-985-5100
Mailing Address - Fax:
Practice Address - Street 1:3997 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE 230
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2832
Practice Address - Country:US
Practice Address - Phone:770-935-0500
Practice Address - Fax:770-935-0880
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics