Basic Information
| Provider Information | |||||||||
| NPI: | 1588019368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMILLE | ||||||||
| FirstName: | MARTINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 JESSE HILL JR DR SE STE 310 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303033049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042518866 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 49 JESSE HILL JR DR SE STE 310 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303033049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042518866 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2016 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 82125 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.