Provider Demographics
NPI:1518227719
Name:REECE, BLAIR ROSE ABELSON (MD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:ROSE ABELSON
Last Name:REECE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:ROSE
Other - Last Name:ABELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-433-6039
Mailing Address - Fax:423-433-6060
Practice Address - Street 1:325 N STATE OF FRANKLIN RD FL 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-439-7280
Practice Address - Fax:423-439-7314
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-00453207R00000X
FLME123586207R00000X
TN57675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015096200Medicaid
TNQ038346Medicaid