Basic Information
| Provider Information | |||||||||
| NPI: | 1780317313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORDERS | ||||||||
| FirstName: | CAMERON | ||||||||
| MiddleName: | DEQUAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT. LA 22763, PASADENA | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665234268 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2810 PREMIERE PKWY STE 500 | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300978912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665234268 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2022 | ||||||||
| LastUpdateDate: | 07/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.