Provider Demographics
NPI:1871946723
Name:CAMPBELL, JUANITA (EDD)
Entity type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:100 OAK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9512
Mailing Address - Country:US
Mailing Address - Phone:478-361-6851
Mailing Address - Fax:
Practice Address - Street 1:100 OAK LAKE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-9512
Practice Address - Country:US
Practice Address - Phone:478-361-6851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional