1093797466 NPI number — ELVIE RIGSBY CAMPBELL PHD EDS MED MS

Table of content: ELVIE RIGSBY CAMPBELL PHD EDS MED MS (NPI 1093797466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093797466 NPI number — ELVIE RIGSBY CAMPBELL PHD EDS MED MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
ELVIE
Provider Middle Name:
RIGSBY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD EDS MED MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093797466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2281 HIGHWAY 37
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMILLA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31730-6935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-336-7068
Provider Business Mailing Address Fax Number:
229-336-1434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
533 W 3RD AVE
Provider Second Line Business Practice Location Address:
THE RENAISSANCE CENTER
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31701-1917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-889-7200
Provider Business Practice Location Address Fax Number:
229-889-7393
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC004004 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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