Provider Demographics
NPI:1437167194
Name:BLACKMON PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:BLACKMON PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-212-6441
Mailing Address - Street 1:7714 CONNER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3559
Mailing Address - Country:US
Mailing Address - Phone:865-212-6350
Mailing Address - Fax:
Practice Address - Street 1:7714 CONNER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3559
Practice Address - Country:US
Practice Address - Phone:865-212-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care