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General NPI Number Information
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NPI Number | 1205921574
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Entity Type | Individual
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Provider Name | CHARLES LARRY CAMPBELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 19 DOCTORS WAY STE C
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-1118
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Country | US
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Telephone | 706-439-6380
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Fax |
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Provider Business Mailing Address
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Address Line | 19 DOCTORS WAY STE C
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-1118
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Country | US
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Telephone | 706-439-6380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number | 52031
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 52031
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 52031
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number | 82064
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License Number State | GA
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