=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467380907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH CAZORT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2026
-----------------------------------------------------
Last Update Date | 05/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8212 HARBOUR CHASE LOOP
-----------------------------------------------------
City | OOLTEWAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37363-2578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-951-9069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8212 HARBOUR CHASE LOOP
-----------------------------------------------------
City | OOLTEWAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37363-2578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-951-9069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084B0040X
-----------------------------------------------------
Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
-----------------------------------------------------
License Number | 42056
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 42056
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0805X
-----------------------------------------------------
Taxonomy Name | Geriatric Psychiatry Physician
-----------------------------------------------------
License Number | 42056
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 42056
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------