Provider Demographics
NPI:1669651055
Name:MATTHEW W CAMP OPHTHALMOLOGY LLC
Entity Type:Organization
Organization Name:MATTHEW W CAMP OPHTHALMOLOGY LLC
Other - Org Name:GEORGIA MOUNTAIN OPHTHALMOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-253-2267
Mailing Address - Street 1:150 INTERSTATE SOUTH DR.
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143
Mailing Address - Country:US
Mailing Address - Phone:706-253-2267
Mailing Address - Fax:678-454-7331
Practice Address - Street 1:150 INTERSTATE SOUTH DR.
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:706-253-2267
Practice Address - Fax:678-454-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700258Medicare PIN