Provider Demographics
NPI:1497949549
Name:W E BENNETT MD
Entity Type:Organization
Organization Name:W E BENNETT MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-882-9775
Mailing Address - Street 1:2305 N GATEWAY AVE UNIT 9
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2025
Mailing Address - Country:US
Mailing Address - Phone:865-882-9775
Mailing Address - Fax:865-882-7804
Practice Address - Street 1:2305 N GATEWAY AVE UNIT 9
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2025
Practice Address - Country:US
Practice Address - Phone:865-882-9775
Practice Address - Fax:865-882-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716991Medicare PIN