Provider Demographics
NPI:1457821373
Name:CAMPBELL, SHENA
Entity type:Individual
Prefix:MRS
First Name:SHENA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHENA
Other - Middle Name:
Other - Last Name:OGLETREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 CARLISLE CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7437
Mailing Address - Country:US
Mailing Address - Phone:404-764-0562
Mailing Address - Fax:
Practice Address - Street 1:1372 PEACHTREE ST NE
Practice Address - Street 2:STE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3203
Practice Address - Country:US
Practice Address - Phone:470-964-1700
Practice Address - Fax:678-288-5639
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPRN208455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily