Provider Demographics
NPI:1275558397
Name:CAMPBELL, DEBRA KAY (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
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 1:1546 SHINING ORE DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2218
Mailing Address - Country:US
Mailing Address - Phone:731-445-1474
Mailing Address - Fax:615-377-0000
Practice Address - Street 1:7110 TOWN CENTER WAY STE 4
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1609
Practice Address - Country:US
Practice Address - Phone:615-660-0000
Practice Address - Fax:615-377-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4076835OtherBLUE CROSS/ BLUE SHIELD
TN3887438Medicare ID - Type Unspecified
TN4076835OtherBLUE CROSS/ BLUE SHIELD