Healthcare Provider Details

I. General information

NPI: 1750769725
Provider Name (Legal Business Name): JARED MICHAEL CAMPBELL MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ABERCORN ST STE 302
SAVANNAH GA
31401-4069
US

IV. Provider business mailing address

127 ABERCORN ST STE 302
SAVANNAH GA
31401-4069
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-9742
  • Fax: 912-354-8920
Mailing address:
  • Phone: 912-352-9742
  • Fax: 912-354-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006851
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: