Healthcare Provider Details

I. General information

NPI: 1205939550
Provider Name (Legal Business Name): TREADWELL CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 E HIGHWAY 76 SUITE 6
MULLINS SC
29574-6038
US

IV. Provider business mailing address

PO BOX 1033
MULLINS SC
29574-1033
US

V. Phone/Fax

Practice location:
  • Phone: 843-431-9882
  • Fax: 843-431-9879
Mailing address:
  • Phone: 843-431-9882
  • Fax: 843-431-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14038
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: