Healthcare Provider Details

I. General information

NPI: 1609169713
Provider Name (Legal Business Name): THE CAMELLIA FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 COVINGTON PIKE SUITE 200
MEMPHIS TN
38128-5048
US

IV. Provider business mailing address

3030 COVINGTON PIKE SUITE 200
MEMPHIS TN
38128-5048
US

V. Phone/Fax

Practice location:
  • Phone: 901-432-5727
  • Fax: 901-384-6309
Mailing address:
  • Phone: 901-432-5727
  • Fax: 901-384-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13931
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40403
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40403
License Number StateTN

VIII. Authorized Official

Name: MRS. CAMELLIA RODNEY
Title or Position: PRESIDENT
Credential: RN
Phone: 901-753-0423