Provider Demographics
NPI:1881166163
Name:HADLEY, CAMILLIA RAE
Entity type:Individual
Prefix:
First Name:CAMILLIA
Middle Name:RAE
Last Name:HADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 STERLING GREENE LN APT F3
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-1523
Mailing Address - Country:US
Mailing Address - Phone:931-212-1168
Mailing Address - Fax:
Practice Address - Street 1:604 S WALL ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3797
Practice Address - Country:US
Practice Address - Phone:931-680-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker