Provider Demographics
NPI:1639753148
Name:CAMELLIA DERMATOLOGY, PC
Entity Type:Organization
Organization Name:CAMELLIA DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-450-3700
Mailing Address - Street 1:1851 N MCKENZIE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-450-3700
Mailing Address - Fax:251-263-6333
Practice Address - Street 1:1851 N MCKENZIE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-450-3700
Practice Address - Fax:251-263-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty