Provider Demographics
NPI:1396166716
Name:MISSY L CAMPBELL
Entity type:Organization
Organization Name:MISSY L CAMPBELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PCA/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:LORENE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-347-6945
Mailing Address - Street 1:203 GIBSON WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-5256
Mailing Address - Country:US
Mailing Address - Phone:864-347-6945
Mailing Address - Fax:
Practice Address - Street 1:203 GIBSON WOODS TRL
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-5256
Practice Address - Country:US
Practice Address - Phone:864-347-6945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization