Provider Demographics
NPI:1902008162
Name:CAMPBELL CUNNINGHAM TAYLOR PC
Entity Type:Organization
Organization Name:CAMPBELL CUNNINGHAM TAYLOR PC
Other - Org Name:CAMPBELL, CUNNINGHAM, & TAYLOR OPTICAL DISPENSARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORD.
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-2127
Mailing Address - Street 1:1124 E WEISGARBER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2686
Mailing Address - Country:US
Mailing Address - Phone:865-584-0905
Mailing Address - Fax:865-584-3892
Practice Address - Street 1:1124 E WEISGARBER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2686
Practice Address - Country:US
Practice Address - Phone:865-584-0905
Practice Address - Fax:865-584-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN645010002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371152Medicaid
TN3371152Medicaid
TN645010002Medicare NSC