Provider Demographics
NPI:1003377573
Name:BURKHART, WILLIAM BLAYLOCK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BLAYLOCK
Last Name:BURKHART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8848 CEDAR SPRINGS LN STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5416
Mailing Address - Country:US
Mailing Address - Phone:865-540-6857
Mailing Address - Fax:865-401-3865
Practice Address - Street 1:8848 CEDAR SPRINGS LN STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5416
Practice Address - Country:US
Practice Address - Phone:865-540-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN65334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program