Provider Demographics
NPI:1851353155
Name:BENNETT, FREDDIE JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:FREDDIE
Middle Name:JAMES
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FRED
Other - Middle Name:JAMES
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2908 TAZEWELL PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1878
Mailing Address - Country:US
Mailing Address - Phone:865-688-8999
Mailing Address - Fax:865-688-8090
Practice Address - Street 1:2908 TAZEWELL PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1878
Practice Address - Country:US
Practice Address - Phone:865-688-8999
Practice Address - Fax:865-688-8090
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26895207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA93212Medicare UPIN
TN38604032Medicare PIN
TN38064031Medicare PIN