Healthcare Provider Details

I. General information

NPI: 1528016672
Provider Name (Legal Business Name): ROBERT C. CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PERRY HWY STE 104
HAWKINSVILLE GA
31036-6748
US

IV. Provider business mailing address

202 PERRY HWY STE 104
HAWKINSVILLE GA
31036-6748
US

V. Phone/Fax

Practice location:
  • Phone: 478-783-4924
  • Fax: 478-473-4905
Mailing address:
  • Phone: 478-783-4924
  • Fax: 478-473-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number032527
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: