Provider Demographics
NPI:1497734073
Name:BENNETT, CAMILLA C (MD)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLA
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:200 FORT SANDERS WEST BLVD
Mailing Address - Street 2:STE 107, MDB 1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3357
Mailing Address - Country:US
Mailing Address - Phone:865-670-1003
Mailing Address - Fax:865-670-1004
Practice Address - Street 1:200 FORT SANDERS WEST BLVD
Practice Address - Street 2:STE 107, MDB 1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3357
Practice Address - Country:US
Practice Address - Phone:865-670-1003
Practice Address - Fax:865-670-1004
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-06-15
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000027512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013407Medicaid
TNQ013407Medicaid
TN3096977Medicaid