Basic Information
| Provider Information | |||||||||
| NPI: | 1437404589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRKWOOD | ||||||||
| FirstName: | CAMERON | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 PEACHTREE ST NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046864411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 PEACHTREE ST NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046864411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2012 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN288877 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 102773301 0001 | 05 | PA | MEDICAID | 9137853 | 01 | PA | AETNA NON HMO | OTHER | 8515034 | 01 | PA | AETNA HMO | OTHER | P01076733 | 01 | PA | RAILROAD MEDICARE | OTHER |