Healthcare Provider Details

I. General information

NPI: 1427507375
Provider Name (Legal Business Name): CAMPBELL CUNNINGHAM & TAYLOR, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 N BROADWAY ST STE 103
KNOXVILLE TN
37918-2066
US

IV. Provider business mailing address

4829 N BROADWAY ST STE 103
KNOXVILLE TN
37918-2066
US

V. Phone/Fax

Practice location:
  • Phone: 865-851-8558
  • Fax: 865-500-8153
Mailing address:
  • Phone: 865-851-8558
  • Fax: 865-500-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD16011
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD21400
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD29986
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD34217
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD49890
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOD1240
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOD2250
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOD00520
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOD03062
License Number StateTN
# 10
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOD2937
License Number StateTN

VIII. Authorized Official

Name: RHONDA M GARRISON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 865-584-2127