=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245638303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMIA CAMPBELL DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2014
-----------------------------------------------------
Last Update Date | 02/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5780 C H JAMES PKWY STE 280
-----------------------------------------------------
City | POWDER SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30127-6076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-943-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1221 SPRING CRK SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30311-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-366-6404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN122217
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------