Provider Demographics
NPI:1598277626
Name:CAMPBELL, MARY N
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:N
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 SOUTHERN COMFORT DR
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-8102
Mailing Address - Country:US
Mailing Address - Phone:864-626-8377
Mailing Address - Fax:
Practice Address - Street 1:1000 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1313
Practice Address - Country:US
Practice Address - Phone:864-626-8377
Practice Address - Fax:864-752-0806
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care