Provider Demographics
NPI:1669420469
Name:ANDY, CAMILLE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:LEE
Last Name:ANDY
Suffix:
Gender:F
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-996-2173
Mailing Address - Fax:336-996-3254
Practice Address - Street 1:4443 JESSUP GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9934
Practice Address - Country:US
Practice Address - Phone:336-663-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64251207Q00000X
NC9701220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5718773OtherAETNA
NC891160GMedicaid
NC1160GOtherBCBSNC
NC28689OtherPARTNERS MEDICARE
NC71483OtherMEDCOST
G81129Medicare UPIN
NC5718773OtherAETNA
NC891160GMedicaid