Provider Demographics
NPI:1932180759
Name:CAMPBELL, RICHARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 80883
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-0883
Mailing Address - Country:US
Mailing Address - Phone:706-549-8114
Mailing Address - Fax:706-549-0151
Practice Address - Street 1:1620 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6008
Practice Address - Country:US
Practice Address - Phone:770-868-5644
Practice Address - Fax:770-868-5650
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048030208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0683833OtherCIGNA
GA800610OtherBLUE CROSS
GA230000000OtherUS DEPT. OF LABOR W/C
GA464731OtherWELLCARE
GAP00631288OtherRAILROAD MEDICARE
GA000906672Medicaid
GA05BDHQZMedicare PIN