Provider Demographics
NPI:1194386201
Name:CAMPBELL, PAMELA JULIET (BA, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JULIET
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1861
Mailing Address - Country:US
Mailing Address - Phone:407-701-1156
Mailing Address - Fax:
Practice Address - Street 1:403 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1861
Practice Address - Country:US
Practice Address - Phone:407-701-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-12194174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN