Active NPI
Camia Imani Coburn
- Attendant Care Provider
- Douglasville, GA
National Provider Identifier
1861122236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Attendant Care Provider
- License
- 374567876
- Practice address
- 3492 Highway 5 Apt 702
Douglasville, GA 30135-6911 - Phone
- (404) 455-5851
- NPI assigned
- Jun 16, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | 374567876 | GA | Primary |
Addresses
Primary practice location
3492 Highway 5 Apt 702
Douglasville, GA 30135-6911
Mailing address
3492 Highway 5 Apt 702
Douglasville, GA 30135-6911
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | blackmindsarentdark@mail.com | Health Information Exchange (HIE) | |
| Direct Messaging Address | blackmindsarentdark@mail.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 374567876 | GA | MD | Attendant Care Provider |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655337600000",
"number": "1861122236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3492 HIGHWAY 5 APT 702",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "301356911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3492 HIGHWAY 5 APT 702",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "301356911",
"telephone_number": "404-455-5851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COBURN",
"first_name": "CAMIA",
"middle_name": "IMANI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-16",
"last_updated": "2022-06-16",
"certification_date": "2022-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": "GA",
"license": "374567876",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "blackmindsarentdark@mail.com",
"affiliation": "N",
"endpointDescription": "device",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "email",
"address_1": "245 Grandview Ln",
"city": "Powder Springs",
"state": "GA",
"country_code": "US",
"postal_code": "301278759",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "blackmindsarentdark@mail.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "device",
"address_1": "245 Grandview Ln",
"city": "Powder Springs",
"state": "GA",
"country_code": "US",
"postal_code": "301278759",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Douglasville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.