Provider Demographics
NPI:1912767807
Name:BAYLESS, CAMELLIA ANN
Entity Type:Individual
Prefix:
First Name:CAMELLIA
Middle Name:ANN
Last Name:BAYLESS
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 1:6408 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-1723
Mailing Address - Country:US
Mailing Address - Phone:810-250-0756
Mailing Address - Fax:
Practice Address - Street 1:6408 ORIOLE DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-1723
Practice Address - Country:US
Practice Address - Phone:810-250-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home