| Name: | Camellia Imaging, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 09 Dec 2015 (9 years ago) |
| Entity Number: | 000-351-469 |
| Register Number: | 000351469 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Registered Office Street Address: | 251 OAK VIEW DRIVEINDIAN SPRINGS, AL 35124 |
| Registered Office Street Address ZIP Code: | 35124 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316495997 | 2016-09-13 | 2017-01-18 | 2068 VALLEYDALE RD, HOOVER, AL, 352442092, US | 2068 VALLEYDALE RD, HOOVER, AL, 352442092, US | |||||||||||||||||||||||||
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| Phone | +1 205-544-2828 |
| Fax | 2057831208 |
| Fax | 2052670192 |
Authorized person
| Name | MONIKA TATARIA |
| Role | PRESIDENT |
| Phone | 2055442828 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| License Number | MD.30928 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1750597670 |
| Name | Role | Address |
|---|---|---|
| COOPER, ROBERT | Agent | 3590 B PELHAM PKWY #164PELHAM, AL 35124 |
| Name | Role | Address |
|---|---|---|
| MCWILLIAMS, VAUGHN | Organizer | 2805 2ND AVENUE SOUTH STE 200BIRMINGHAM, AL 35233-4124 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
