Healthcare Provider Details

I. General information

NPI: 1053926576
Provider Name (Legal Business Name): MARCIA B CAMPBELL CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7002 ANNIE WALK
LITHONIA GA
30038-4675
US

IV. Provider business mailing address

7002 ANNIE WALK
LITHONIA GA
30038-4675
US

V. Phone/Fax

Practice location:
  • Phone: 813-312-3848
  • Fax: 470-300-7778
Mailing address:
  • Phone: 813-312-3848
  • Fax: 470-300-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: