Provider Demographics
NPI:1700164217
Name:CAMPBELL, MARVA A (RN)
Entity Type:Individual
Prefix:MS
First Name:MARVA
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 GREENSFERRY AVE SW APT 1703
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-4390
Mailing Address - Country:US
Mailing Address - Phone:315-982-3896
Mailing Address - Fax:
Practice Address - Street 1:565 GREENSFERRY AVE SW APT 1703
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314
Practice Address - Country:US
Practice Address - Phone:315-982-3896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214520163W00000X
NY554229163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse