Individual
DR. KEN D. BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 E MAIN ST, CAMDEN, TN 38320-1734
(731) 584-1430
(731) 584-1439
Mailing address
30 E MAIN ST, CAMDEN, TN 38320-1734
(731) 584-1430
(731) 584-1439
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35476
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4067078
BCBS-T PROVIDER #
TN
01
—
44D-1016448
CLIA #
TN
01
—
7679503
AETNA PROVIDER #
TN
01
—
930113436
PALMETTO GPA RAILROAD MEDICARE
TN
Enumeration date
01/09/2006
Last updated
06/04/2008
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