Provider Demographics
NPI:1346632635
Name:CORNFORTH, CANDICE FREEMAN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:FREEMAN
Last Name:CORNFORTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:265 BROOKVIEW CENTRE WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4052
Mailing Address - Country:US
Mailing Address - Phone:865-769-6671
Mailing Address - Fax:
Practice Address - Street 1:16 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1414
Practice Address - Country:US
Practice Address - Phone:865-769-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198886367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered