Healthcare Provider Details

I. General information

NPI: 1497734073
Provider Name (Legal Business Name): CAMILLA C BENNETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FORT SANDERS WEST BLVD STE 107, MDB 1
KNOXVILLE TN
37922-3357
US

IV. Provider business mailing address

200 FORT SANDERS WEST BLVD STE 107, MDB 1
KNOXVILLE TN
37922-3357
US

V. Phone/Fax

Practice location:
  • Phone: 865-670-1003
  • Fax: 865-670-1004
Mailing address:
  • Phone: 865-670-1003
  • Fax: 865-670-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000027512
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: