Provider Demographics
NPI:1598302036
Name:WALTMAN, CAMMI
Entity Type:Individual
Prefix:
First Name:CAMMI
Middle Name:
Last Name:WALTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 PT SALTER RD
Mailing Address - Street 2:
Mailing Address - City:POULAN
Mailing Address - State:GA
Mailing Address - Zip Code:31781-3846
Mailing Address - Country:US
Mailing Address - Phone:229-881-4865
Mailing Address - Fax:
Practice Address - Street 1:1068 PT SALTER RD
Practice Address - Street 2:
Practice Address - City:POULAN
Practice Address - State:GA
Practice Address - Zip Code:31781-3846
Practice Address - Country:US
Practice Address - Phone:229-881-4865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer