Healthcare Provider Details

I. General information

NPI: 1649102062
Provider Name (Legal Business Name): THERESA CAMPBELL MSN, RN, CCRN, NPD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MOSAIC CIR
POOLER GA
31322-5031
US

IV. Provider business mailing address

4609 LANSDOWNE ST
SAVANNAH GA
31405-4218
US

V. Phone/Fax

Practice location:
  • Phone: 912-547-1506
  • Fax:
Mailing address:
  • Phone: 912-547-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN235433
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: