Provider Demographics
NPI:1427237080
Name:CAMPBELL, JUSTIN D (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:121 N 20TH ST
Mailing Address - Street 2:#6
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5449
Mailing Address - Country:US
Mailing Address - Phone:334-749-3385
Mailing Address - Fax:334-705-3421
Practice Address - Street 1:121 N 20TH ST
Practice Address - Street 2:#6
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5449
Practice Address - Country:US
Practice Address - Phone:334-749-3385
Practice Address - Fax:334-705-3421
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL30157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL122053Medicaid