Organization
CAMILLA MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KITTY BEASLEY (GENERAL PARTNER)
(229) 328-7593
Entity
Organization
Contact information
Practice address
138 E BROAD ST, CAMILLA, GA 31730-1809
(229) 351-4125
Mailing address
138 E BROAD ST, CAMILLA, GA 31730-1809
(229) 351-4125
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XXX
XXX
—
Enumeration date
05/20/2020
Last updated
05/20/2020
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