Healthcare Provider Details

I. General information

NPI: 1679780845
Provider Name (Legal Business Name): JOYCE CAMPBELL FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 A GAINESVILLE HIGHWAY SOUTH
ALTO GA
30510
US

IV. Provider business mailing address

6531 HIGHWAY 254
CLEVELAND GA
30528-6315
US

V. Phone/Fax

Practice location:
  • Phone: 706-776-0653
  • Fax: 706-776-4958
Mailing address:
  • Phone: 706-219-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN149456
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: