Provider Demographics
NPI:1609843812
Name:CAMPBELL, ROBERT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:DAVID
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1005 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-6141
Mailing Address - Country:US
Mailing Address - Phone:478-621-2100
Mailing Address - Fax:478-744-0481
Practice Address - Street 1:1005 BOULDER DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032
Practice Address - Country:US
Practice Address - Phone:478-621-2100
Practice Address - Fax:478-744-0481
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000226366BMedicaid
GAD44996Medicare UPIN