Healthcare Provider Details

I. General information

NPI: 1134192529
Provider Name (Legal Business Name): SHERI CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 DALLAS HWY SUITE 301
VILLA RICA GA
30180-1264
US

IV. Provider business mailing address

119 AMBULANCE DR SUITE 202
CARROLLTON GA
30117-3857
US

V. Phone/Fax

Practice location:
  • Phone: 770-456-3850
  • Fax: 770-456-3826
Mailing address:
  • Phone: 770-456-3850
  • Fax: 770-456-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22614
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number058445
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: