DR RQYMOND J OTIS (NPI# 1649449323) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649449323 |
| Entity Type | Organization |
| Organization Name | DR RQYMOND J OTIS |
| Other Organization Name | CAMILLA FAMILY MEDICINE |
| Practice Address |
24 N Ellis St Camilla GA 31730-1502 |
| Practice Telephone | 2293367343 |
| Practice Fax Number | 2293367400 |
| Mailing Telephone | 2293367343 |
| Mailing Fax Number | 2293367400 |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-02-26 |
| Authorized Official Name | DR. RAYMOND JERRY OTIS SR. (PRESIDENT) |
| Authorized Official Telephone | 2293367343 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
42685 | GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 0720266D | 05 |
| Other Name | Type Code |
|---|---|
| Camilla Family Medicine | Doing Business As Name - Organization |
| Street Address |
24 N ELLIS ST |
| City | CAMILLA |
| State | GA |
| Zip Code | 31730-1502 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104844422 | Raymond J Otis Sr. | Family Medicine | 24 N Ellis St, Camilla, GA 31730-1502 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700310059 | Phoebe Primary Care of Camilla | Clinic/Center | 725 Us Highway 19 S, Camilla, GA 31730 | 2017-04-13 |
| 1134661028 | Montreal Biggins Sr. | Counselor | 198 South Mcarthur Drive, Camilla, GA 31730 | 2016-11-09 |
| 1447639307 | Ledora Inman | Counselor | 198 S. Mac Arthur Drive, Camila, GA 31730 | 2015-05-26 |
| 1336533652 | Southern Therapeutic Massage Studio LLC | Massage Therapist | 88 W. Broad St, Camilla, GA 31730 | 2015-03-25 |
| 1013306604 | Jamekah Brooks | Counselor | 198 S Macarthur Drive, Camilla, GA 31730 | 2015-01-20 |
| 1063811651 | Develle Miller | Counselor | 198 S. Macarthur, Camilla, GA 31730 | 2014-08-19 |
| 1679980247 | Amanda Bryant | Counselor | 198 S. Macarthur Dr., Camilla, GA 31730 | 2014-07-16 |
| 1578993945 | Ted Hall | Counselor | 218 S. Mcarthur Drive, Camilla, GA 31730 | 2013-11-20 |
| 1700216280 | Michael D Fowler I | Case Management | 198 S. Macarthur Drive, Camilla, GA 31730 | 2013-11-19 |
| 1750644753 | Sally Niazi | Pharmacist | 266 E Broad Street, Camilla, GA 31730 | 2012-06-25 |
| Find all providers in zip 31730 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114450665 | Phoebe Primary Care of Camilla | Clinic/Center | 48 Us Highway 19 S, Camilla, GA 31730-1960 | 2017-04-11 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.