Healthcare Provider Details

I. General information

NPI: 1639259559
Provider Name (Legal Business Name): ROBERT W. CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY.71 NORTH RM 139-B
PINEVILLE LA
71360
US

IV. Provider business mailing address

3561 MCKENZIE DR
MACON GA
31204-2711
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0010
  • Fax:
Mailing address:
  • Phone: 318-442-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number035577
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: