Provider Demographics
NPI:1639469992
Name:CONAWAY, BENJAMIN LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LEE
Last Name:CONAWAY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HAUN ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-2935
Mailing Address - Country:US
Mailing Address - Phone:423-341-9725
Mailing Address - Fax:
Practice Address - Street 1:7540 DANNAHER WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4013
Practice Address - Country:US
Practice Address - Phone:865-859-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer