Provider Demographics
NPI:1477621928
Name:J. BLACKWELL & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:J. BLACKWELL & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:T
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-865-8330
Mailing Address - Street 1:PO BOX 280956
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-0956
Mailing Address - Country:US
Mailing Address - Phone:615-865-8330
Mailing Address - Fax:615-865-8082
Practice Address - Street 1:3109 JOHN A MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-1509
Practice Address - Country:US
Practice Address - Phone:615-865-8330
Practice Address - Fax:615-865-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024165101YP2500X
TNMD018561174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732511Medicare ID - Type Unspecified
TN3039288Medicare ID - Type Unspecified
TNE09549Medicare UPIN