Provider Demographics
NPI:1144398678
Name:CAMPBELL, YARI P (MD)
Entity Type:Individual
Prefix:
First Name:YARI
Middle Name:P
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 1:7244 BAILEY COVE RD SE STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2868
Mailing Address - Country:US
Mailing Address - Phone:256-261-3340
Mailing Address - Fax:256-261-3337
Practice Address - Street 1:7900 BAILEY COVE RD SE # 7
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3324
Practice Address - Country:US
Practice Address - Phone:256-261-3340
Practice Address - Fax:256-261-3337
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076363207R00000X, 208000000X
ALMD.35198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL226757Medicaid
MI464322310Medicaid
AL215325Medicaid
YC076363OtherCHAMPUS-CHAMPUS
AL190448Medicaid
AL10208I3683OtherMEDICARE
AL195682Medicaid
700H262220OtherBLUE CROSS-BLUE CROSS
YC076363OtherCOMMERCIAL-COMMERCIAL NUMBER