Provider Demographics
NPI:1871933358
Name:CAMERON, JOHNNY JR (SURGICAL ASSIST-CERT)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:CAMERON
Suffix:JR
Gender:M
Credentials:SURGICAL ASSIST-CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 LEBANON PIKE APT B313
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-5026
Mailing Address - Country:US
Mailing Address - Phone:615-428-9889
Mailing Address - Fax:
Practice Address - Street 1:2000 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-0001
Practice Address - Country:US
Practice Address - Phone:615-284-5215
Practice Address - Fax:615-284-4914
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN99-222246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN24OtherSURGICAL FIRST ASSISTANT