Provider Demographics
NPI:1558518431
Name:CAMPILII, MARY (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CAMPILII
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5212
Mailing Address - Country:US
Mailing Address - Phone:706-401-4116
Mailing Address - Fax:
Practice Address - Street 1:4901 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-5212
Practice Address - Country:US
Practice Address - Phone:706-401-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIRO07892OtherLICENSE NUMBER