Provider Demographics
NPI:1457906059
Name:CAMPBELL, SANDRA K (LAT ATC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:K
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-8248
Mailing Address - Country:US
Mailing Address - Phone:706-246-5018
Mailing Address - Fax:706-245-2924
Practice Address - Street 1:181 SPRING ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-8248
Practice Address - Country:US
Practice Address - Phone:706-246-5018
Practice Address - Fax:706-245-2924
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0000307602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer