Healthcare Provider Details

I. General information

NPI: 1326088816
Provider Name (Legal Business Name): PATRICIA A CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110A SPRINGHALL DR LIBERTY DOCTORS, LLC PATRICIA A CAMPBELL MD
GOOSE CREEK SC
29445-5335
US

IV. Provider business mailing address

PO BOX 13955 LIBERTY DOCTORS, LLC PATRICIA A CAMPBELL MD
CHARLESTON SC
29422-3955
US

V. Phone/Fax

Practice location:
  • Phone: 843-266-2520
  • Fax: 843-553-4436
Mailing address:
  • Phone: 843-225-8304
  • Fax: 843-225-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16192
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: