Healthcare Provider Details

I. General information

NPI: 1982603015
Provider Name (Legal Business Name): ALFRED WRAY CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E WOOD ST
SPARTANBURG SC
29303-3040
US

IV. Provider business mailing address

PO BOX 96782
CHARLOTTE NC
28296-6782
US

V. Phone/Fax

Practice location:
  • Phone: 864-560-6229
  • Fax:
Mailing address:
  • Phone: 704-973-5500
  • Fax: 704-973-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number28586
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: