Provider Demographics
NPI:1104990258
Name:CAMPBELL, LYNNDA JOY (FNP C)
Entity type:Individual
Prefix:MS
First Name:LYNNDA
Middle Name:JOY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP C
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Mailing Address - Street 1:2920 MARIETTA HWY
Mailing Address - Street 2:STE 142
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114
Mailing Address - Country:US
Mailing Address - Phone:770-704-0057
Mailing Address - Fax:770-704-0223
Practice Address - Street 1:2920 MARIETTA HWY
Practice Address - Street 2:STE 142
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:770-704-0057
Practice Address - Fax:770-704-0223
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN126988NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA411013961AMedicaid