Provider Demographics
NPI:1528016672
Name:CAMPBELL, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PERRY HWY
Mailing Address - Street 2:STE 104
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-6748
Mailing Address - Country:US
Mailing Address - Phone:478-783-4924
Mailing Address - Fax:478-473-4905
Practice Address - Street 1:202 PERRY HWY
Practice Address - Street 2:STE 104
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-783-4924
Practice Address - Fax:478-473-4905
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032527208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00544288JMedicaid
GA020050912OtherRAILROAD MEDICARE
GA00544288JMedicaid
GA02BBCSWMedicare PIN