Courtney Brynne Campbell, PA-C
Individual provider Active NPI Physician Assistant · Holly Springs, GA
NPI 1467895409 · NPPES record last updated Nov 10, 2021
Key facts
- NPI
- 1467895409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 7442 (GA)
- Practice address
- 1120 Wellstar Way Ste 105
Holly Springs, GA 30114-8952 - Phone
- (678) 494-2500
- NPI assigned
- Apr 9, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Emory University School of Medicine, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Wellstar Medical Group LLC
Practice addresses (Care Compare)
4477 Towne Lake Pkwy
Suite 130
Woodstock, GA 30189-6720
Phone (770) 249-5620
5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222
5655 Atlanta Hwy
Alpharetta, GA 30004-5208
Phone (770) 691-0819
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.93 of 100
- Quality
- 82.14
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150630002088 | GA | Practitioner - Physician Assistant | 0840438065 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9107144 | FL | MD | Physician Assistant |
| 7442 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Medical Group, LLC | Current |
Accepting new patients | |
| Wellstar Medical Group, LLC | Current |
Accepting new patients | |
| Wellstar Cardiovascular Medicine, LLC | Past | Accepting new patients |
Locations
3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752
1120 Wellstar Way
Ste 105
Holly Springs, GA 30114
Phone (678) 494-2500
5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222
677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435
3747 Roswell Rd
Ste 107
Marietta, GA 30062
Phone (470) 956-0150
805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9107144 | FL | |
| Physician Assistant | 363A00000X | 7442 | GA | Yes |
Addresses
Primary practice location
1120 Wellstar Way Ste 105
Holly Springs, GA 30114-8952
Mailing address
1120 Wellstar Way Ste 105
Holly Springs, GA 30114-8952
Phone (678) 494-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HE879Z | Other | FL | PTAN |
Other providers in Holly Springs, GA
- Mary Blalock
- Body Expressions the Aesthetic Edge
- Randall James Boyd
- Karen Buhariwalla
- Daniel Cadavid Duque
- Daquesha Capre Chever
- Sydney Anabel Colon
- Sarah Scott Cool
- Stacey Collene Cox
- Creekside Chiropractic LLC
All providers in Holly Springs, GA · Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.