Active NPI
Diane L Campbell, MD
- Specialist
- Erwin, TN
National Provider Identifier
1215935838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MD25069
- Practice address
- 108 Gay St
Erwin, TN 37650-1228 - Phone
- (423) 743-8400
- Fax
- (423) 743-6888
- NPI assigned
- Jul 8, 2005
- Last updated
- Jul 17, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MD25069 | TN | Primary |
Addresses
Primary practice location
108 Gay St
Erwin, TN 37650-1228
Mailing address
PO Box 759
Erwin, TN 37650-0759
Phone (423) 743-8400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4004557 | Medicaid | TN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD25069 | TN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216252800000",
"number": "1215935838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 759",
"city": "ERWIN",
"state": "TN",
"postal_code": "376500759",
"telephone_number": "423-743-8400",
"fax_number": "423-743-6888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 GAY ST",
"city": "ERWIN",
"state": "TN",
"postal_code": "376501228",
"telephone_number": "423-743-8400",
"fax_number": "423-743-6888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "DIANE",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-08",
"last_updated": "2008-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TN",
"license": "MD25069",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4004557",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Erwin, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.