Provider Demographics
NPI:1831497619
Name:CAMP CREEK WOMEN'S HEALTH CENTER
Entity Type:Organization
Organization Name:CAMP CREEK WOMEN'S HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-344-2229
Mailing Address - Street 1:3885 PRINCETON LAKES WAY SW
Mailing Address - Street 2:SUITE 412
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5589
Mailing Address - Country:US
Mailing Address - Phone:404-344-2229
Mailing Address - Fax:404-574-6715
Practice Address - Street 1:1136 CLEVELAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3618
Practice Address - Country:US
Practice Address - Phone:404-344-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMP CREEK WOMEN'S HEALTH CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty