Healthcare Provider Details

I. General information

NPI: 1063405629
Provider Name (Legal Business Name): JAMES EARNEST CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 W COUNTRY GABLES DR.
GLENDALE AZ
85306
US

IV. Provider business mailing address

5350 W BELL RD. STE C-122 #602
GLENDALE AZ
85308
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-2400
  • Fax: 602-439-1414
Mailing address:
  • Phone: 602-439-2400
  • Fax: 602-439-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5458
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5458
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: