Provider Demographics
NPI:1922259696
Name:CAMMON, THOMESHIA LATOY (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:THOMESHIA
Middle Name:LATOY
Last Name:CAMMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HOWARD FARM DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6081
Mailing Address - Country:US
Mailing Address - Phone:770-758-8964
Mailing Address - Fax:770-292-6535
Practice Address - Street 1:2000 HOWARD FARM DR STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6081
Practice Address - Country:US
Practice Address - Phone:770-758-8964
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1049363A00000X
GA5752363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003121190AMedicaid
GA202I974262Medicare PIN
GA003121190AMedicaid