Provider Demographics
NPI:1639878408
Name:EATON, CAMMIE GISELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAMMIE
Middle Name:GISELLE
Last Name:EATON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CAMMIE
Other - Middle Name:EATON
Other - Last Name:DELLA VALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1605 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-6427
Mailing Address - Country:US
Mailing Address - Phone:404-673-2410
Mailing Address - Fax:
Practice Address - Street 1:306 LAUREL ST STE C
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2124
Practice Address - Country:US
Practice Address - Phone:770-537-1266
Practice Address - Fax:770-537-1700
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor