Healthcare Provider Details

I. General information

NPI: 1407610967
Provider Name (Legal Business Name): MARVIN WILLIAM CAMPBELL II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 COPLEY RD
AKRON OH
44320-2766
US

IV. Provider business mailing address

1293 COPLEY RD
AKRON OH
44320-2766
US

V. Phone/Fax

Practice location:
  • Phone: 330-374-1199
  • Fax:
Mailing address:
  • Phone: 330-374-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberRA.163851
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: