Provider Demographics
NPI:1356678882
Name:CAMPBELL CUNNINGHAM TAYLOR PC
Entity Type:Organization
Organization Name:CAMPBELL CUNNINGHAM TAYLOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-584-2127
Mailing Address - Street 1:962 DOLLY PARTON PKWY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3707
Mailing Address - Country:US
Mailing Address - Phone:865-428-8000
Mailing Address - Fax:
Practice Address - Street 1:962 DOLLY PARTON PKWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3707
Practice Address - Country:US
Practice Address - Phone:865-428-8000
Practice Address - Fax:865-428-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371152OtherMEDICARE
TN0645010002OtherDME
TN3371152Medicaid