Provider Demographics
NPI:1992125769
Name:CAMP, ALEXANDRA VICTORIA (PA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:VICTORIA
Last Name:CAMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ASHLEY PARK BLVD APT 215
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1825 HIGHWAY 34 E
Practice Address - Street 2:SUITE 1200
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6423
Practice Address - Country:US
Practice Address - Phone:678-854-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7181363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical