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General NPI Number Information
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NPI Number | 1750720058
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Entity Type | Organization
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Legal Business Name | CAMELLIA HOME HEALTH OF SOUTHEAST TENNESSEE, LLC
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 6711 MOUNTAIN VIEW RD SUITE 105
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City | OOLTEWAH
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State | TN
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Zip | 37363-6668
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Country | US
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Telephone | 423-414-3017
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Fax | 423-238-1199
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Provider Business Mailing Address
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Address Line | 135 MAYFAIR RD
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City | HATTIESBURG
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State | MS
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Zip | 39402-1464
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Country | US
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Telephone | 601-544-2903
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Fax | 601-579-6991
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | MR. WILFORD A PAYNE III
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Credential |
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Telephone | 601-544-2903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 107
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License Number State | TN
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