Provider Demographics
NPI:1306642244
Name:CAMMON, LADIRUS M
Entity type:Individual
Prefix:
First Name:LADIRUS
Middle Name:M
Last Name:CAMMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 PINEY FIELD RD
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3783
Mailing Address - Country:US
Mailing Address - Phone:205-246-9349
Mailing Address - Fax:
Practice Address - Street 1:514 N BRIGHTLEAF BLVD STE 1702
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4486
Practice Address - Country:US
Practice Address - Phone:205-246-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered