Provider Demographics
NPI:1063618932
Name:CAMPBELL, LAUREL ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:257 BANCORP SOUTH PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7582
Mailing Address - Country:US
Mailing Address - Phone:731-660-7971
Mailing Address - Fax:731-660-8739
Practice Address - Street 1:1720 WOODLAWN AVE STE 1
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1300
Practice Address - Country:US
Practice Address - Phone:731-287-4500
Practice Address - Fax:731-287-4804
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2022-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010023232207R00000X
TN65917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ077823Medicaid