Healthcare Provider Details

I. General information

NPI: 1093294522
Provider Name (Legal Business Name): ANDREEN C CAMPBELL-HYLICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 11/13/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

527 CARLTON DR E
PALMETTO GA
30268-1098
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4000
  • Fax:
Mailing address:
  • Phone: 404-936-1371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN167838
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN167838
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: