Healthcare Provider Details

I. General information

NPI: 1427138098
Provider Name (Legal Business Name): WALTER D CAMPBELL MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N LEHMBERG RD
COLUMBUS MS
39702-5554
US

IV. Provider business mailing address

114 N LEHMBERG RD
COLUMBUS MS
39702-5554
US

V. Phone/Fax

Practice location:
  • Phone: 662-329-2955
  • Fax: 662-370-1236
Mailing address:
  • Phone: 662-329-2955
  • Fax: 662-370-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036040823
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31731
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: