Individual
BENNIE W WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
412 DEVONIA ST, HARRIMAN, TN 37748-2009
(865) 882-1323
(865) 291-3228
Mailing address
PO BOX 636019, CINCINNATI, OH 45263-6019
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
018427
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000361799
ANTHEM BCBS OF KY
KY
01
—
3058965
BCBS OF TENNESSEE
TN
05
—
3065071
—
TN
01
—
P00255557
RAILROAD MEDICARE
TN
Enumeration date
07/05/2006
Last updated
11/19/2007
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