Provider Demographics
NPI:1376811224
Name:MEDDERS, CAMELIA (RN)
Entity Type:Individual
Prefix:
First Name:CAMELIA
Middle Name:
Last Name:MEDDERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5588 FORKWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8009
Mailing Address - Country:US
Mailing Address - Phone:254-247-8724
Mailing Address - Fax:
Practice Address - Street 1:5588 FORKWOOD DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8009
Practice Address - Country:US
Practice Address - Phone:254-247-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218244163W00000X
TX641386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse