Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS8796 | TN |
NPI | 1104009646 |
---|---|
Provider Name | Dr. Joshua A Campbell |
First Address | Nashville, TN 37244-0301 |
Second Address | Knoxville, TN 37934-2838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2007 |
Last Update Date | 05/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1507709 | (05) | TN |