Provider Demographics
NPI:1558134866
Name:CAMERON, FATIMA CHANTELLA (NP)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:CHANTELLA
Last Name:CAMERON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 POPLAR RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2582
Mailing Address - Country:US
Mailing Address - Phone:678-633-3500
Mailing Address - Fax:
Practice Address - Street 1:795 POPLAR RD STE 110
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2582
Practice Address - Country:US
Practice Address - Phone:678-633-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271813363L00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner