Healthcare Provider Details

I. General information

NPI: 1659331742
Provider Name (Legal Business Name): KEITH E. CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MARILYN LN
ALCOA TN
37701-2118
US

IV. Provider business mailing address

431 MARILYN LN
ALCOA TN
37701-2118
US

V. Phone/Fax

Practice location:
  • Phone: 865-233-5858
  • Fax: 865-233-5870
Mailing address:
  • Phone: 865-233-5858
  • Fax: 865-233-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD0000037908
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000037908
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberMD0000037908
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: