MEDICARE: DR. GLORIA CAMPBELL-D'HUE MD

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	207N00000X	Dermatology Physician	024412	GA

General Provider Information

NPI Number	:	1669651766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA CAMPBELL-D'HUE MD

Provider Business Mailing Address
First Line	:	2950 STONE HOGAN CONNECTOR RD SW
Second Line	:	BUILDING 4
City	:	ATLANTA
State	:	GA
Zip	:	30331-2837
Country	:	US
Telephone Number	:	404-349-7440
Fax Number	:	404-349-7402

Provider Business Practice Location Address
First Line	:	2950 STONE HOGAN CONNECTOR RD SW
Second Line	:	BUILDING 4
City	:	ATLANTA
State	:	GA
Zip	:	30331-2837
Country	:	US
Telephone Number	:	404-349-7440
Fax Number	:	404-349-7402

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

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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