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Individual

MR. MICHAEL ANDREW WADE CAMPBELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
4550 AMYSAYE WALK NW, ACWORTH, GA 30101-8342
(404) 917-7992
Mailing address
4550 AMYSAYE WALK NW, ACWORTH, GA 30101-8342
(404) 917-7992

Taxonomy

Speciality
Code
Description
License number
State
372600000X
Adult Companion
404144
GA
3747P1801X
Personal Care Attendant
Primary
404144
GA
374U00000X
Home Health Aide
404144
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
404144
STATE ISSUE NUMBER
GA
Enumeration date
11/26/2018
Last updated
11/26/2018
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