Provider Demographics
NPI:1215994470
Name:CAMP, PAIGE BLOODWORTH (MEDICAL DOCTOR)
Entity type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:BLOODWORTH
Last Name:CAMP
Suffix:
Gender:F
Credentials:MEDICAL DOCTOR
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:111 MARBLE MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1047
Mailing Address - Country:US
Mailing Address - Phone:770-422-1013
Mailing Address - Fax:770-514-5996
Practice Address - Street 1:130 OAKSIDE CT
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2456
Practice Address - Country:US
Practice Address - Phone:770-479-7711
Practice Address - Fax:770-479-0330
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040630207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52731927OtherBCBS
GA070012620OtherMEDICARE RAILROAD
GA07BBSDKMedicare PIN
G58935Medicare UPIN