Healthcare Provider Details

I. General information

NPI: 1144502477
Provider Name (Legal Business Name): CAMPBELL COUNTY HMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 JACKSBORO PIKE
LA FOLLETTE TN
37766-3003
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 423-907-1700
  • Fax: 423-907-1711
Mailing address:
  • Phone: 615-778-8071
  • Fax: 615-628-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JAMES PATRICK WRIGHT
Title or Position: SR. DIRECTOR
Credential:
Phone: 615-778-1502