Healthcare Provider Details

I. General information

NPI: 1639405483
Provider Name (Legal Business Name): CAMPBELL CUNNINGHAM TAYLOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 SMITHVIEW DR
MARYVILLE TN
37803-6100
US

IV. Provider business mailing address

628 SMITHVIEW DR
MARYVILLE TN
37803-6100
US

V. Phone/Fax

Practice location:
  • Phone: 865-984-7012
  • Fax: 865-981-4401
Mailing address:
  • Phone: 865-984-7012
  • Fax: 865-981-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD021400
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD0034217
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD0008625
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD029986
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOD001240
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOD002250
License Number StateTN
# 7
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD016011
License Number StateTN

VIII. Authorized Official

Name: MRS. RHONDA M GARRISON
Title or Position: CREDENTIALS COORDINATOR
Credential: BILLING DEPT
Phone: 865-584-2127