Basic Information
Provider Information
NPI: 1407396468
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAMERON
FirstName: NADIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5665 NEW NORTHSIDE DR
Address2: SUITE 320
City: ATLANTA
State: GA
PostalCode: 303285831
CountryCode: US
TelephoneNumber: 7708746907
FaxNumber:  
Practice Location
Address1: 3950 AUSTELL RD
Address2:  
City: AUSTELL
State: GA
PostalCode: 301061121
CountryCode: US
TelephoneNumber: 7707323886
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/24/2017
LastUpdateDate: 02/24/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XRN204487GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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