Healthcare Provider Details

I. General information

NPI: 1093922650
Provider Name (Legal Business Name): TERESA A CAMPBELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DOGWOOD AVE BUILDING 6 VA MEDICAL CENTER
MOUNTAIN HOME TN
37684
US

IV. Provider business mailing address

PO BOX 310
MOUNTAIN HOME TN
37684-0310
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-8038
  • Fax:
Mailing address:
  • Phone: 423-743-6825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number34151
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: