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General NPI Number Information
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NPI Number | 1174109433
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Entity Type | Organization
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Legal Business Name | CAMPBELLRDNUTRITION
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 404 KNOX CT
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City | CANTON
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State | MS
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Zip | 39046-7047
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Country | US
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Telephone | 662-212-2219
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Fax |
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Provider Business Mailing Address
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Address Line | 404 KNOX CT
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City | CANTON
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State | MS
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Zip | 39046-7047
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Country | US
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Telephone | 662-212-2219
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VICTORIA CAMPBELL
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Credential | MS, RDN,LD
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Telephone | 662-292-1545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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