MEDICARE: LOVIETTA LYN CAMPBELL LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	MSW003354	GA

General Provider Information

NPI Number	:	1003987579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOVIETTA LYN CAMPBELL LMSW

Provider Business Mailing Address
First Line	:	4312 OLD MACON RD APT 64
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-8303
Country	:	US
Telephone Number	:	706-569-5563
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 MACON RD
Second Line	:	SUITE 5
City	:	COLUMBUS
State	:	GA
Zip	:	31907-8200
Country	:	US
Telephone Number	:	706-565-5927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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