Healthcare Provider Details

I. General information

NPI: 1467480814
Provider Name (Legal Business Name): MARY PALMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY PALMER CAMPBELL M.D.

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 CLINCH AVE
KNOXVILLE TN
37916-2301
US

IV. Provider business mailing address

PO BOX 15004
KNOXVILLE TN
37901-5004
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-8105
  • Fax: 865-541-8713
Mailing address:
  • Phone: 865-541-8895
  • Fax: 865-633-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20488
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number20488
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: