Provider Demographics
NPI:1518712793
Name:GARNESS, KAMILLE ANNETTE (MD, MPH, CPH, BS)
Entity Type:Individual
Prefix:DR
First Name:KAMILLE
Middle Name:ANNETTE
Last Name:GARNESS
Suffix:
Gender:F
Credentials:MD, MPH, CPH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 EDGEBROOK CIR APT 107
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7470
Mailing Address - Country:US
Mailing Address - Phone:407-556-5892
Mailing Address - Fax:
Practice Address - Street 1:1905 EDGEBROOK CIR APT 107
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7470
Practice Address - Country:US
Practice Address - Phone:407-556-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18148251K00000X
FL09597964208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No251K00000XAgenciesPublic Health or Welfare