Provider Demographics
NPI:1760686711
Name:OVERHOLT, CANDI C (MD)
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:C
Last Name:OVERHOLT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-237-6900
Mailing Address - Fax:423-532-8710
Practice Address - Street 1:150 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2329
Practice Address - Country:US
Practice Address - Phone:423-237-6900
Practice Address - Fax:423-532-8710
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44065207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514430Medicaid
TN3041885Medicare PIN
TN103I110313Medicare PIN
TN1514430Medicaid