Provider Demographics
NPI:1568636322
Name:CAMPBELL, CHARLAYA D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLAYA
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HANNAHS MILL RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-2801
Mailing Address - Country:US
Mailing Address - Phone:706-938-0990
Mailing Address - Fax:706-647-3861
Practice Address - Street 1:100 HIGHWAY 18 W
Practice Address - Street 2:SUITE 201
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-1171
Practice Address - Country:US
Practice Address - Phone:678-359-1700
Practice Address - Fax:706-647-3861
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100702BMedicaid