Provider Demographics
NPI:1952583817
Name:CAMPBELL, GARLON L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GARLON
Middle Name:L
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:534 N 35TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3182
Mailing Address - Country:US
Mailing Address - Phone:252-773-0614
Mailing Address - Fax:252-772-0617
Practice Address - Street 1:534 N 35TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3182
Practice Address - Country:US
Practice Address - Phone:252-773-0614
Practice Address - Fax:252-772-0617
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200701463207L00000X, 208VP0014X
NC2007-01463207LA0401X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919028Medicaid
NC5919028Medicaid