Provider Demographics
NPI:1639405483
Name:CAMPBELL CUNNINGHAM TAYLOR PC
Entity Type:Organization
Organization Name:CAMPBELL CUNNINGHAM TAYLOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING DEPT
Authorized Official - Phone:865-584-2127
Mailing Address - Street 1:628 SMITHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-6100
Mailing Address - Country:US
Mailing Address - Phone:865-984-7012
Mailing Address - Fax:865-981-4401
Practice Address - Street 1:628 SMITHVIEW DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6100
Practice Address - Country:US
Practice Address - Phone:865-984-7012
Practice Address - Fax:865-981-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD016011332B00000X
TNMD021400332B00000X
TNMD0034217332B00000X
TNMD0008625332B00000X
TNMD029986332B00000X
TNOD001240332B00000X
TNOD002250332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN645010002OtherDME
TN3371152OtherMEDICARE
TN3371152Medicaid