Provider Demographics
NPI:1861503906
Name:CAMP CREEK PRIMARY CARE, PC
Entity Type:Organization
Organization Name:CAMP CREEK PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/ BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREEN-CLOPTON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:404-349-2273
Mailing Address - Street 1:PO BOX 90237
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30364-0237
Mailing Address - Country:US
Mailing Address - Phone:404-349-2273
Mailing Address - Fax:404-349-1511
Practice Address - Street 1:3890 REDWINE RD SW
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5509
Practice Address - Country:US
Practice Address - Phone:404-349-2273
Practice Address - Fax:404-349-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty