Provider Demographics
NPI:1285841254
Name:CAMPBELL, BRENT JEREMY (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JEREMY
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-5630
Mailing Address - Fax:423-778-3146
Practice Address - Street 1:1025 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-778-9030
Practice Address - Fax:423-778-9031
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN2018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine