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General NPI Number Information
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NPI Number | 1710979596
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Entity Type | Individual
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Provider Name | ANGELA POTTER CAMPBELL MD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 6401 POPLAR AVE STE 610
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City | MEMPHIS
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State | TN
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Zip | 38119-4806
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Country | US
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Telephone | 901-227-5045
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Fax | 901-224-5043
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 315
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City | MEMPHIS
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State | TN
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Zip | 38120-9401
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Country | US
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Telephone | 901-227-4618
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Fax | 901-447-5054
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36512
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License Number State | TN
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