# CAMELLIA HOME HEALTH OF SOUTHEAST TENNESSEE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750720058
- **Authorized official:** MR. WILFORD A PAYNE III (PRESIDENT / CEO)
- **Authorized official phone:** (601) 544-2903

## Contact information

- **Practice address:** 6711 MOUNTAIN VIEW RD, SUITE 105, OOLTEWAH, TN 37363-6668
- **Practice address phone:** (423) 414-3017
- **Practice address fax:** (423) 238-1199
- **Mailing address:** 135 MAYFAIR RD, HATTIESBURG, MS 39402-1464
- **Mailing address phone:** (601) 544-2903
- **Mailing address fax:** (601) 579-6991

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 107 | TN | Yes |

## Other

- **Enumeration date:** 06/19/2013
- **Last updated:** 06/19/2013