Provider Demographics
NPI:1083675615
Name:CAMPBELL, NIOAKA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NIOAKA
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
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:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:15 MEDICAL PARK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8003
Practice Address - Country:US
Practice Address - Phone:803-434-4300
Practice Address - Fax:803-434-4351
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC225330Medicaid
SC225330Medicaid
I07305Medicare UPIN
AA04384411Medicare ID - Type Unspecified
SCAA04385771Medicare PIN