Provider Demographics
NPI:1265185235
Name:WORTHINGTON, CAMILLE SCHNEIDER (PHD, RDN)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:SCHNEIDER
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:PHD, RDN
Other - Prefix:DR
Other - First Name:CAMILLE
Other - Middle Name:RAGAN
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 51ST ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3921
Mailing Address - Country:US
Mailing Address - Phone:410-952-8979
Mailing Address - Fax:
Practice Address - Street 1:1717 11TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4731
Practice Address - Country:US
Practice Address - Phone:410-952-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3001133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered