Provider Demographics
NPI:1285301580
Name:CAMPBELL, JAVON PATRICK
Entity type:Individual
Prefix:MR
First Name:JAVON
Middle Name:PATRICK
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JAVON
Other - Middle Name:PATRICK
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1907 LANGDON FARM RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-5403
Mailing Address - Country:US
Mailing Address - Phone:213-280-1063
Mailing Address - Fax:
Practice Address - Street 1:3425 N BEND RD STE F
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7660
Practice Address - Country:US
Practice Address - Phone:216-341-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator