Provider Demographics
NPI:1619426566
Name:CAMPBELL CUNNINGHAM & TAYLOR, PC
Entity Type:Organization
Organization Name:CAMPBELL CUNNINGHAM & TAYLOR, PC
Other - Org Name:ANDES OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-2127
Mailing Address - Street 1:4613 PAPERMILL DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1971
Mailing Address - Country:US
Mailing Address - Phone:865-584-8551
Mailing Address - Fax:865-584-0829
Practice Address - Street 1:4613 PAPERMILL DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1971
Practice Address - Country:US
Practice Address - Phone:865-584-8551
Practice Address - Fax:865-584-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1240332B00000X
TNOD2250332B00000X
TNOD0520332B00000X
TNOD3062332B00000X
TNOD2937332B00000X
TNMD16011332B00000X
TNMD21400332B00000X
TNMD29986332B00000X
TNMD34217332B00000X
TNMD49890332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies