# PARKSIDE ADOLESCENT AND ADULT MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124254552
- **Authorized official:** DR. SHERITA MONAI LATIMORE-COLLIER MD (MD)
- **Authorized official phone:** (856) 964-5569

## Contact information

- **Practice address:** 1300 PRINCESS AVE, CAMDEN, NJ 08103-2911
- **Practice address phone:** (856) 964-5569
- **Practice address fax:** (856) 964-0744
- **Mailing address:** 1300 PRINCESS AVE, CAMDEN, NJ 08103-2911
- **Mailing address phone:** (856) 964-5569
- **Mailing address fax:** (856) 964-0744

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0000X | Adolescent Medicine (Internal Medicine) Physician | 25MAO8519200 | NJ | Yes |

## Other

- **Enumeration date:** 05/29/2009
- **Last updated:** 07/30/2009