MEDICARE: DR. RANDON CAMPBELL DDS

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	122300000X	Dentist	DN122386	GA
2	122300000X	Dentist	DN25818	FL

General Provider Information

NPI Number	:	1710565148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDON CAMPBELL DDS

Provider Business Mailing Address
First Line	:	11455 CANAL XING
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-6747
Country	:	US
Telephone Number	:	912-217-4953
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 NORMAN DR STE B
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-3753
Country	:	US
Telephone Number	:	229-269-4607
Fax Number	:

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

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	08/11/2023

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Directions to “ DR. RANDON CAMPBELL DDS” Practice Location

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