Provider Demographics
NPI:1598483521
Name:ANCHOR HEALTH & WELLNESS PLLC
Entity Type:Organization
Organization Name:ANCHOR HEALTH & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:423-429-1126
Mailing Address - Street 1:607 HOLSTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-3592
Mailing Address - Country:US
Mailing Address - Phone:423-968-1772
Mailing Address - Fax:
Practice Address - Street 1:607 HOLSTON AVE STE B
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-3592
Practice Address - Country:US
Practice Address - Phone:423-968-1772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1194289298Medicaid