Provider Demographics
NPI:1508291733
Name:CAMPBELL, TOMMY L (INSURANCE AGENT)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:INSURANCE AGENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HOLIDAY CT STE D7
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1311
Mailing Address - Country:US
Mailing Address - Phone:615-595-7632
Mailing Address - Fax:615-595-7624
Practice Address - Street 1:109 HOLIDAY CT STE D7
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1311
Practice Address - Country:US
Practice Address - Phone:615-595-7632
Practice Address - Fax:615-595-7624
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN773488251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN261342111OtherINSURANCE AGENT