Provider Demographics
NPI:1255991253
Name:CAMPBELL, PATRICIA LURLINE (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LURLINE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 EVELYN GANDY PKWY
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-3947
Mailing Address - Country:US
Mailing Address - Phone:601-584-4309
Mailing Address - Fax:
Practice Address - Street 1:1146 EVELYN GANDY PKWY
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-3947
Practice Address - Country:US
Practice Address - Phone:601-584-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS30585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS30585OtherMEDICAL LICENSE