Provider Demographics
NPI:1669440822
Name:CAMPBELL, TOMMY J (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 558
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0558
Mailing Address - Country:US
Mailing Address - Phone:901-821-8300
Mailing Address - Fax:901-821-8340
Practice Address - Street 1:6799 GREAT OAKS RD
Practice Address - Street 2:250
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-821-8300
Practice Address - Fax:901-821-8340
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN15176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A97136Medicare UPIN
3006697Medicare ID - Type Unspecified