Individual
MRS. CAMILLE D. NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3333 JODECO ROAD, SUITE A, MCDONOUGH, GA 30253
(770) 692-4000
(770) 474-8510
Mailing address
3333 JODECO ROAD, SUITE A, MCDONOUGH, GA 30253
(770) 692-4000
(770) 474-8510
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
045562
GA
207RC0000X
Cardiovascular Disease Physician
193652
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000788796A
—
GA
01
—
045562
GA LICENSE
GA
01
—
110166903
RAIL ROAD MEDICARE
GA
01
—
1760576656
GROUP NPI
GA
01
—
193652
NY LICENSE
NY
Enumeration date
07/26/2006
Last updated
02/22/2024
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