# CAMILLA MEDICAL CLINIC

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

## Provider details

- **NPI number:** 1760005144
- **Authorized official:** KITTY BEASLEY (GENERAL PARTNER)
- **Authorized official phone:** (229) 328-7593

## Contact information

- **Practice address:** 138 E BROAD ST, CAMILLA, GA 31730-1809
- **Practice address phone:** (229) 351-4125
- **Mailing address:** 138 E BROAD ST, CAMILLA, GA 31730-1809
- **Mailing address phone:** (229) 351-4125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/20/2020
- **Last updated:** 05/20/2020