Healthcare Provider Details

I. General information

NPI: 1003987579
Provider Name (Legal Business Name): LOVIETTA LYN CAMPBELL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 MACON RD SUITE 5
COLUMBUS GA
31907-8200
US

IV. Provider business mailing address

4312 OLD MACON RD APT 64
COLUMBUS GA
31907-8303
US

V. Phone/Fax

Practice location:
  • Phone: 706-565-5927
  • Fax:
Mailing address:
  • Phone: 706-569-5563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW003354
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: