Provider Demographics
NPI:1417410580
Name:CAMPBELL, TAMMIE T
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:T
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 DAVID MULLIS RD
Mailing Address - Street 2:
Mailing Address - City:RENTZ
Mailing Address - State:GA
Mailing Address - Zip Code:31075-3262
Mailing Address - Country:US
Mailing Address - Phone:478-290-3626
Mailing Address - Fax:478-277-2710
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:478-277-2710
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker