Provider Demographics
NPI:1093797466
Name:CAMPBELL, ELVIE RIGSBY (PHD EDS MED MS)
Entity Type:Individual
Prefix:
First Name:ELVIE
Middle Name:RIGSBY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD EDS MED MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-6935
Mailing Address - Country:US
Mailing Address - Phone:229-336-7068
Mailing Address - Fax:229-336-1434
Practice Address - Street 1:533 W 3RD AVE
Practice Address - Street 2:THE RENAISSANCE CENTER
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1917
Practice Address - Country:US
Practice Address - Phone:229-889-7200
Practice Address - Fax:229-889-7393
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional