Healthcare Provider Details

I. General information

NPI: 1386727378
Provider Name (Legal Business Name): ANGELA JP CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA J PECK

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CLIFTON RD NE MAILSTOP A32
ATLANTA GA
30329-4018
US

IV. Provider business mailing address

1600 CLIFTON RD NE MAILSTOP A32
ATLANTA GA
30329-4018
US

V. Phone/Fax

Practice location:
  • Phone: 404-639-3376
  • Fax: 404-639-3866
Mailing address:
  • Phone: 404-639-3376
  • Fax: 404-639-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD00040206
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number70353
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: