Provider Demographics
NPI:1063892834
Name:CAMPBELL, DEBORAH ANN (RVT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 MCGUIRE ST NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5267
Mailing Address - Country:US
Mailing Address - Phone:770-218-8840
Mailing Address - Fax:
Practice Address - Street 1:3706 MCGUIRE ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5267
Practice Address - Country:US
Practice Address - Phone:770-218-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAARDMS 102602471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography