Provider Demographics
NPI:1477084267
Name:CAMON, KAMELA MANANTAN (MD)
Entity type:Individual
Prefix:
First Name:KAMELA
Middle Name:MANANTAN
Last Name:CAMON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 NORTHSIDE DR STE M
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1853
Mailing Address - Country:US
Mailing Address - Phone:292-241-0059
Mailing Address - Fax:
Practice Address - Street 1:406 NORTHSIDE DR STE M
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1853
Practice Address - Country:US
Practice Address - Phone:229-241-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144622208000000X
GA101589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105830900Medicaid