Provider Demographics
NPI:1316358757
Name:CAMPELLONE, CHRISTOPHER VINCENT (PROVIDER, HIS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:VINCENT
Last Name:CAMPELLONE
Suffix:
Gender:M
Credentials:PROVIDER, HIS
Other - Prefix:MR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:CAMPELLONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HIS, HAD
Mailing Address - Street 1:3000 MCEVER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5539
Mailing Address - Country:US
Mailing Address - Phone:770-912-0558
Mailing Address - Fax:
Practice Address - Street 1:3000 MCEVER ROAD EXT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5539
Practice Address - Country:US
Practice Address - Phone:770-912-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000859237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1316358757Medicaid