MEDICARE: SARA CAMPBELL M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207VX0000X	Obstetrics Physician	26175	MS
3	207V00000X	Obstetrics & Gynecology Physician	89802	GA

General Provider Information

NPI Number	:	1508200395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA CAMPBELL M.D.

Provider Business Mailing Address
First Line	:	117 FAIRFIELD DR
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3107
Country	:	US
Telephone Number	:	662-534-0029
Fax Number	:	662-534-0008

Provider Business Practice Location Address
First Line	:	117 FAIRFIELD DR
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3107
Country	:	US
Telephone Number	:	662-534-0029
Fax Number	:	662-534-0008

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

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	01/28/2022

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