Active NPI
Marykathryn Campbell
- Athletic Trainer
- Brookhaven, GA
National Provider Identifier
1073262127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-436
- Practice address
- 3843 Ashford RDG NE
Brookhaven, GA 30319-1895 - Phone
- (404) 444-5372
- NPI assigned
- Mar 23, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1394 | SC | |
| Athletic Trainer | 2255A2300X | AT-436 | HI | Primary |
Addresses
Primary practice location
3843 Ashford RDG NE
Brookhaven, GA 30319-1895
Mailing address
3843 Ashford RDG NE
Brookhaven, GA 30319-1895
Phone (404) 444-5372
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT-436 | HI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721001600000",
"number": "1073262127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3843 ASHFORD RDG NE",
"city": "BROOKHAVEN",
"state": "GA",
"postal_code": "303191895",
"telephone_number": "404-444-5372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3843 ASHFORD RDG NE",
"city": "BROOKHAVEN",
"state": "GA",
"postal_code": "303191895",
"telephone_number": "404-444-5372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "MARYKATHRYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-23",
"last_updated": "2024-07-15",
"certification_date": "2024-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "SC",
"license": "1394",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "HI",
"license": "AT-436",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookhaven, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.