Provider Demographics
NPI:1902402118
Name:LINDO-WILSON, CAMILLE ANTOINETTE (MSN FNP)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:ANTOINETTE
Last Name:LINDO-WILSON
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DONOVAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2823
Mailing Address - Country:US
Mailing Address - Phone:404-916-2162
Mailing Address - Fax:
Practice Address - Street 1:1544 BASS RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-7510
Practice Address - Country:US
Practice Address - Phone:404-916-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL220192363L00000X
GARN220192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner