Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 26531 | TN |
N | 207PP0204X | Pediatric Emergency Physician | 26531 | TN |
N | 2080P0204X | Pediatric Emergency Doctor | 26531 | TN |
NPI | 1356341044 |
---|---|
Provider Name | Dr. Camilla R Forsythe |
First Address | Knoxville, TN 37932-1983 |
Second Address | Memphis, TN 38120-2373 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 02/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G11720 | (02) | TN |