Provider Demographics
NPI:1962660340
Name:UNITED STATES COAST GUARD, AIR STATION ATLANTIC CITY
Entity Type:Organization
Organization Name:UNITED STATES COAST GUARD, AIR STATION ATLANTIC CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:609-677-2028
Mailing Address - Street 1:FAA TECH CENTER BLDG 350
Mailing Address - Street 2:USCG MEDICAL DEPT
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08405
Mailing Address - Country:US
Mailing Address - Phone:609-677-2007
Mailing Address - Fax:609-677-2143
Practice Address - Street 1:FAA TECH CENTER BLDG 350
Practice Address - Street 2:USCG MEDICAL DEPT
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08405
Practice Address - Country:US
Practice Address - Phone:609-677-2007
Practice Address - Fax:609-677-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient