Individual
GLENN A CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4209 LINCOLN ROAD, HATTIESBURG, MS 39402
(601) 579-5400
(601) 261-3521
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5830
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11345
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010478
—
MS
01
—
080015084
RAILROAD MEDICARE
—
01
—
1558924
AMERICAN ADMIN GROUP
MS
Enumeration date
08/01/2006
Last updated
07/08/2020
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