Provider Demographics
NPI:1992762041
Name:CAMPBELL, JOHN H (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5430
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36205-0430
Mailing Address - Country:US
Mailing Address - Phone:256-241-2276
Mailing Address - Fax:256-238-0555
Practice Address - Street 1:1007 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1195
Practice Address - Country:US
Practice Address - Phone:256-413-6480
Practice Address - Fax:256-413-6493
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL39742086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51545249OtherBC & BS OF AL
AL51000960OtherBC & BS OF AL
AL510I020002OtherMEDICARE PTAN
AL51537150OtherBC & BS OF AL
AL000000960Medicaid
AL009912177Medicaid
AL000000960Medicaid
AL510I020002OtherMEDICARE PTAN