MEDICARE: GAY 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	183500000X	Pharmacist	016318	GA
2	183500000X	Pharmacist	106318	GA

General Provider Information

NPI Number	:	1780269381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAY CAMPBELL

Provider Business Mailing Address
First Line	:	130 ARLINGTON DR
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30016-1168
Country	:	US
Telephone Number	:	404-406-7688
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 PEACHTREE ST NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3141
Country	:	US
Telephone Number	:	404-406-7688
Fax Number	:

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

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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Directions to “ GAY CAMPBELL ” Practice Location

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