Provider Demographics
NPI:1902933229
Name:KERSEY, CAMERON CALDWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:CALDWELL
Last Name:KERSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:717 20TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8920
Practice Address - Country:US
Practice Address - Phone:706-653-0292
Practice Address - Fax:706-653-1230
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000254982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00882624OtherRR MEDICARE
GA793905377JMedicaid
GA202I308288Medicare UPIN
GA793905377JMedicaid