Healthcare Provider Details

I. General information

NPI: 1285334789
Provider Name (Legal Business Name): LINDA FRYE CAMPBELL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

1125 WHARFSIDE CT
GREENSBORO GA
30642-3438
US

V. Phone/Fax

Practice location:
  • Phone: 954-401-4185
  • Fax:
Mailing address:
  • Phone: 678-234-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number966
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: