Healthcare Provider Details

I. General information

NPI: 1841566650
Provider Name (Legal Business Name): EARL VENDRYES CAMPBELL III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD STE 130
ROSWELL GA
30076-4946
US

IV. Provider business mailing address

2500 HOSPITAL BLVD STE 130
ROSWELL GA
30076-4946
US

V. Phone/Fax

Practice location:
  • Phone: 470-267-1520
  • Fax: 770-999-2673
Mailing address:
  • Phone: 470-267-1520
  • Fax: 770-999-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number64186
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number86620
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: