Basic Information
| Provider Information | |||||||||
| NPI: | 1922070747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HELTON | ||||||||
| FirstName: | CAMILLA | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HALES | ||||||||
| OtherFirstName: | CAMILLA | ||||||||
| OtherMiddleName: | E. | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 751803 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368932440 | ||||||||
| FaxNumber: | 3368932470 | ||||||||
| Practice Location | |||||||||
| Address1: | 7114 VILLAGE MEDICAL CIR | ||||||||
| Address2: | |||||||||
| City: | CLEMMONS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270128004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368932440 | ||||||||
| FaxNumber: | 3368932470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0001-03063 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1285682310 | 01 | NC | WSCA GRP NPI # | OTHER | 2753007A | 01 | NC | MEDICARE PTAN | OTHER | NC5260A | 01 | NC | MEDICARE PTAN | OTHER | NC5260B | 01 | NC | MEDICARE PTAN | OTHER |