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General NPI Number Information
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NPI Number | 1477768844
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Entity Type | Organization
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Legal Business Name | CAMPBELL FAMILY PRACTICE
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 2835 E HIGHWAY 76 STE 6
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City | MULLINS
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State | SC
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Zip | 29574-6038
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Country | US
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Telephone | 843-431-9882
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Fax | 843-431-9879
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Provider Business Mailing Address
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Address Line | PO BOX 1033
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City | MULLINS
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State | SC
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Zip | 29574-1033
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Country | US
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Telephone | 843-431-9882
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Fax | 843-431-9879
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Authorized Official
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Title or Position | OWNER
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Name | TREADWELL CAMPBELL
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Credential | MD
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Telephone | 843-431-9882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14038
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License Number State | SC
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