Basic Information
| Provider Information | |||||||||
| NPI: | 1669420469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDY | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751803 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369962173 | ||||||||
| FaxNumber: | 3369963254 | ||||||||
| Practice Location | |||||||||
| Address1: | 4443 JESSUP GROVE RD | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274109934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366634600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 64251 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 9701220 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5718773 | 01 | NC | AETNA | OTHER | 891160G | 05 | NC | MEDICAID | 1160G | 01 | NC | BCBSNC | OTHER | 28689 | 01 | NC | PARTNERS MEDICARE | OTHER | 71483 | 01 | NC | MEDCOST | OTHER |