Provider Demographics
NPI:1598718678
Name:CAMPBELL, JEANNE M (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1909
Mailing Address - Country:US
Mailing Address - Phone:843-723-9433
Mailing Address - Fax:
Practice Address - Street 1:11 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1909
Practice Address - Country:US
Practice Address - Phone:843-723-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110183683OtherRAILROAD MEDICARE
SC126125Medicaid
SC571020809014OtherBCBS SC
SC571020809019OtherTRICARE SC
SC126125Medicaid
SC1497874424Medicare PIN
SC1790735975Medicare PIN
SCC613686795Medicare PIN
SC110183683OtherRAILROAD MEDICARE
SCC61368Medicare UPIN