Provider Demographics
NPI:1942186564
Name:CAMPBELL, ALISHIA MARIE (NP)
Entity type:Individual
Prefix:
First Name:ALISHIA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3792
Mailing Address - Country:US
Mailing Address - Phone:305-205-2423
Mailing Address - Fax:
Practice Address - Street 1:40 FULTON ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5090
Practice Address - Country:US
Practice Address - Phone:786-548-9597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP003904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGAA-NP003904OtherGEORGIA BOARD OF NURSING