Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 58951 | GA |
Y | 207VX0000X | Obstetrician | 58951 | GA |
NPI | 1053531954 |
---|---|
Provider Name | Dr. Cassie Nicol Campbell |
First Address | Atlanta, GA 30339 |
Second Address | Athens, GA 30606-2797 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 15/06/2018 |