Provider Demographics
NPI:1588239131
Name:CAMPBELL, DEVIN
Entity Type:Individual
Prefix:MR
First Name:DEVIN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 ROTONDO WAY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-5233
Mailing Address - Country:US
Mailing Address - Phone:470-503-9117
Mailing Address - Fax:
Practice Address - Street 1:527 ROTONDO WAY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5233
Practice Address - Country:US
Practice Address - Phone:470-503-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education