Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 52031 | TN |
N | 207RC0000X | Internist - Cardiovascular Disease | 52031 | TN |
NPI | 1205921574 |
---|---|
Provider Name | Charles Larry Campbell JR. |
First Address | Chattanooga, TN 37403-2589 |
Second Address | Chattanooga, TN 37403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 12/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I69938 | (02) | KY |