Healthcare Provider Details

I. General information

NPI: 1770120479
Provider Name (Legal Business Name): CAMERON M RAYMENT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 PAPERMILL DR
KNOXVILLE TN
37919-4858
US

IV. Provider business mailing address

PO BOX 52948
KNOXVILLE TN
37950-2948
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-8229
  • Fax: 865-212-0163
Mailing address:
  • Phone: 865-306-5675
  • Fax: 865-584-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4061
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: