Provider Demographics
NPI:1760550446
Name:CAMPBELL, SHIRLEY (CRTT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 NATION RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-3768
Mailing Address - Country:US
Mailing Address - Phone:864-446-3517
Mailing Address - Fax:
Practice Address - Street 1:698 NATION RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-3768
Practice Address - Country:US
Practice Address - Phone:864-446-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1670227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1944Medicaid
SC3853830001Medicare PIN