Healthcare Provider Details

I. General information

NPI: 1457203069
Provider Name (Legal Business Name): TAWNYA CAMPBELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 RIVERSIDE DR
MACON GA
31210-2513
US

IV. Provider business mailing address

3400 RIVERSIDE DR
MACON GA
31210-2513
US

V. Phone/Fax

Practice location:
  • Phone: 478-474-5600
  • Fax: 478-471-6769
Mailing address:
  • Phone: 478-474-5600
  • Fax: 478-471-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP294670
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: