Provider Demographics
NPI:1053313635
Name:CAMPBELL, GEORGE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BILLY
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:111 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-1668
Mailing Address - Country:US
Mailing Address - Phone:864-647-1820
Mailing Address - Fax:864-647-0403
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1668
Practice Address - Country:US
Practice Address - Phone:864-647-1820
Practice Address - Fax:864-647-0403
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC117705Medicaid
SC4729Medicare PIN
SC117705Medicaid