Provider Demographics
NPI:1326706516
Name:CAMPAGNA, MICAELA ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:ROSE
Last Name:CAMPAGNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4361
Mailing Address - Country:US
Mailing Address - Phone:404-242-7831
Mailing Address - Fax:
Practice Address - Street 1:4025 LAWRENCEVILLE HWY NW STE A
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2876
Practice Address - Country:US
Practice Address - Phone:770-559-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine