Provider Demographics
NPI:1053926576
Name:CAMPBELL, MARCIA B (CNA)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:B
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 ANNIE WALK
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4675
Mailing Address - Country:US
Mailing Address - Phone:813-312-3848
Mailing Address - Fax:470-300-7778
Practice Address - Street 1:7002 ANNIE WALK
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-4675
Practice Address - Country:US
Practice Address - Phone:813-312-3848
Practice Address - Fax:470-300-7778
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide