Provider Demographics
NPI:1518598945
Name:SMOTHERS, CAMERON CHRISTOPHER ADAM (BS, CNIM)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:CHRISTOPHER ADAM
Last Name:SMOTHERS
Suffix:
Gender:M
Credentials:BS, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 JULIAS WAY NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6219
Mailing Address - Country:US
Mailing Address - Phone:770-769-7619
Mailing Address - Fax:
Practice Address - Street 1:2855 JULIAS WAY NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-6219
Practice Address - Country:US
Practice Address - Phone:770-795-1408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45122084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology