Provider Demographics
NPI:1619496247
Name:CAMPBELL, MAKESHA
Entity Type:Individual
Prefix:
First Name:MAKESHA
Middle Name:
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 1:509 N WESTOVER BLVD APT 1034
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1930
Mailing Address - Country:US
Mailing Address - Phone:229-869-4467
Mailing Address - Fax:
Practice Address - Street 1:509 N WESTOVER BLVD APT 1034
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1930
Practice Address - Country:US
Practice Address - Phone:229-869-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor