Individual
MS. RAQUEL M DECAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1700 HOSPITAL SOUTH DR, SUITE 302, AUSTELL, GA 30106-6810
(770) 739-0999
(678) 324-4275
Mailing address
1838 AMERICAN WAY, LAWRENCEVILLE, GA 30043-6611
(770) 995-7622
(770) 995-7854
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004821
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20526
—
NE
05
—
666236332C
—
GA
05
—
666236332D
—
GA
05
—
666236332E
—
GA
05
—
666236332F
—
GA
05
—
666236332G
—
GA
Enumeration date
12/19/2005
Last updated
11/05/2019
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