Basic Information
| Provider Information | |||||||||
| NPI: | 1831202803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | MAURA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 WINWOOD DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370871340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154436838 | ||||||||
| FaxNumber: | 6155479782 | ||||||||
| Practice Location | |||||||||
| Address1: | 1411 W BADDOUR PKWY | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370872513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154436006 | ||||||||
| FaxNumber: | 6154436086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 19237 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 25462 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 31391 | KY | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 01043524A | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3045571 | 01 | BCBS GROUP | OTHER |