Healthcare Provider Details

I. General information

NPI: 1568636322
Provider Name (Legal Business Name): CHARLAYA D CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGHWAY 18 W SUITE 201
BARNESVILLE GA
30204-1171
US

IV. Provider business mailing address

210 HANNAHS MILL RD
THOMASTON GA
30286-2801
US

V. Phone/Fax

Practice location:
  • Phone: 678-359-1700
  • Fax: 706-647-3861
Mailing address:
  • Phone: 706-938-0990
  • Fax: 706-647-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: