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General NPI Number Information
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NPI Number | 1376337089
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Entity Type | Individual
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Provider Name | TANIELIA T CAMPBELL
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 1300 RIDENOUR BLVD NW STE 300
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City | KENNESAW
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State | GA
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Zip | 30152-4402
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Country | US
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Telephone | 770-702-1806
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Fax |
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Provider Business Mailing Address
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Address Line | 434 WATERBURY WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6079
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Country | US
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Telephone | 646-703-3376
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 13669
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License Number State | GA
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