Provider Demographics
NPI:1801815444
Name:CAMPAGNA, JAMES HARRISON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HARRISON
Last Name:CAMPAGNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2576
Mailing Address - Country:US
Mailing Address - Phone:229-247-3300
Mailing Address - Fax:229-247-1131
Practice Address - Street 1:2418 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2576
Practice Address - Country:US
Practice Address - Phone:229-247-3300
Practice Address - Fax:229-247-1131
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033806207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA033806OtherLICENSE
GA00451261AMedicaid
GABC2597447OtherDEA NUMBER
GAE82124Medicare UPIN
GA033806OtherLICENSE