Provider Demographics
NPI:1003454687
Name:CAMPBELL THOMAS, KATHERINE ELAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELAINE
Last Name:CAMPBELL THOMAS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1306 NATHAN MAULDIN DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7245
Mailing Address - Country:US
Mailing Address - Phone:678-437-7486
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-14
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183592363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty