Basic Information
| Provider Information | |||||||||
| NPI: | 1952535064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | TYLER | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 PROFESSIONAL DR STE 165 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300463300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702773056 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 575 PROFESSIONAL DR STE 165 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300463300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702773056 | ||||||||
| FaxNumber: | 8552045244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 01/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN159855 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.