Healthcare Provider Details

I. General information

NPI: 1073327342
Provider Name (Legal Business Name): DARIUS CAMPBELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W CUNNINGHAM AVE
TERRY MS
39170-8156
US

IV. Provider business mailing address

PO BOX 1086
TERRY MS
39170-1086
US

V. Phone/Fax

Practice location:
  • Phone: 601-238-6083
  • Fax:
Mailing address:
  • Phone: 601-238-6083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: