Provider Demographics
NPI:1053331421
Name:CAMPBELL, JAMES K (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 TEGARDEN RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15190 COMMUNITY RD STE 240
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3483
Practice Address - Country:US
Practice Address - Phone:228-575-7104
Practice Address - Fax:228-539-6766
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22745207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891004LMedicaid
NC1004LOtherBCBS
NC891004LMedicaid
NC2230920BMedicare PIN
NC2203923Medicare ID - Type UnspecifiedPART B
G46082Medicare UPIN