Provider Demographics
NPI:1922269612
Name:CAMP CREEK PEDIATRICS LLC
Entity Type:Organization
Organization Name:CAMP CREEK PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-349-2273
Mailing Address - Street 1:1415 HIGHWAY 85 N
Mailing Address - Street 2:SUITE 310-246
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4035
Mailing Address - Country:US
Mailing Address - Phone:404-349-2273
Mailing Address - Fax:
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:30331-5582
Practice Address - Country:US
Practice Address - Phone:404-349-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049655261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty