Healthcare Provider Details

I. General information

NPI: 1285612564
Provider Name (Legal Business Name): CAMDEN MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HOSPITAL DR.
CAMDEN TN
38320
US

IV. Provider business mailing address

160 HOSPITAL DR.
CAMDEN TN
38320
US

V. Phone/Fax

Practice location:
  • Phone: 731-279-0600
  • Fax: 731-279-0555
Mailing address:
  • Phone: 731-279-0600
  • Fax: 731-279-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAPN0000006407
License Number StateTN

VIII. Authorized Official

Name: MS. DEBORAH T WOOD
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 731-279-0600