Provider Demographics
NPI:1508508185
Name:CAMPBELL, LILLIE (DO)
Entity Type:Individual
Prefix:
First Name:LILLIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BRIGHTWATER DR
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5156
Mailing Address - Country:US
Mailing Address - Phone:910-892-1000
Mailing Address - Fax:
Practice Address - Street 1:215 BRIGHTWATER DR
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-5156
Practice Address - Country:US
Practice Address - Phone:910-892-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL90006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine