Provider Demographics
NPI:1558832345
Name:CAMPBELL, NATHANIEL FRANKLIN (SOIDC)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:FRANKLIN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 PARAMOUNT WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-6457
Mailing Address - Country:US
Mailing Address - Phone:707-972-9826
Mailing Address - Fax:
Practice Address - Street 1:RR 612 EVERETT CREEK RD
Practice Address - Street 2:CAMP LEJUENE
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-440-1942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman