Provider Demographics
NPI:1104544014
Name:CAMPBELL, ERICKA SHAVAE (CNA)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:SHAVAE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 RUSSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-6751
Mailing Address - Country:US
Mailing Address - Phone:225-239-0666
Mailing Address - Fax:
Practice Address - Street 1:4439 RUSSWOOD AVE
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-6751
Practice Address - Country:US
Practice Address - Phone:225-239-0666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care