Provider Demographics
NPI:1548803927
Name:DR. CAMERON AND ASSOCIATES OF INDIAN TRAIL PLLC
Entity Type:Organization
Organization Name:DR. CAMERON AND ASSOCIATES OF INDIAN TRAIL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PRACTICE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-674-1022
Mailing Address - Street 1:5850 W HIGHWAY 74 STE 135
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5850 W HIGHWAY 74 STE 135
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3441
Practice Address - Country:US
Practice Address - Phone:704-815-5513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental