Individual
CAMERON PARK SLANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2000 10TH AVE STE 270, COLUMBUS, GA 31901-3706
(706) 992-6590
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3171
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
6577
TN
207XX0801X
Orthopaedic Trauma Physician
Primary
93733
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2020
Last updated
01/27/2026
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