Provider Demographics
NPI:1669893566
Name:BLAIR, JOSHUA C (NP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
Last Name:BLAIR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 842
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-0842
Mailing Address - Country:US
Mailing Address - Phone:423-263-5400
Mailing Address - Fax:423-263-0674
Practice Address - Street 1:315 GRADY RD
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1903
Practice Address - Country:US
Practice Address - Phone:423-263-5400
Practice Address - Fax:423-263-0674
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003425Medicaid