Provider Demographics
NPI:1376337089
Name:CAMPBELL, TANIELIA T
Entity type:Individual
Prefix:
First Name:TANIELIA
Middle Name:T
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 1:434 WATERBURY WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6079
Mailing Address - Country:US
Mailing Address - Phone:646-703-3376
Mailing Address - Fax:
Practice Address - Street 1:434 WATERBURY WAY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6079
Practice Address - Country:US
Practice Address - Phone:646-703-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program