MEDICARE: MRS. SHENA CAMPBELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN208455	GA

General Provider Information

NPI Number	:	1457821373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHENA CAMPBELL

Provider Business Mailing Address
First Line	:	30 CARLISLE CT
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30016-7437
Country	:	US
Telephone Number	:	404-764-0562
Fax Number	:

Provider Business Practice Location Address
First Line	:	1372 PEACHTREE ST NE
Second Line	:	STE 100
City	:	ATLANTA
State	:	GA
Zip	:	30309-3203
Country	:	US
Telephone Number	:	470-964-1700
Fax Number	:	678-288-5639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	07/11/2025

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