Provider Demographics
NPI:1497833834
Name:CAMPBELL, KEVIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1382
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:200 FORT SANDERS WEST BLVD STE 304
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3360
Practice Address - Country:US
Practice Address - Phone:865-531-8848
Practice Address - Fax:865-693-1398
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38743651Medicaid
TN38743651Medicare PIN
TNH32140Medicare UPIN
TN38743651Medicaid