Provider Demographics
NPI:1467895409
Name:CAMPBELL, COURTNEY BRYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BRYNNE
Last Name:CAMPBELL
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 1:1120 WELLSTAR WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8952
Mailing Address - Country:US
Mailing Address - Phone:678-494-2500
Mailing Address - Fax:
Practice Address - Street 1:1120 WELLSTAR WAY STE 105
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30114-8952
Practice Address - Country:US
Practice Address - Phone:678-494-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9107144363A00000X
GA7442363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHE879ZOtherPTAN