Provider Demographics
NPI:1740254820
Name:BLALOCK, WILLIAM E III (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:BLALOCK
Suffix:III
Gender:M
Credentials:MD
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 28345
Mailing Address - Street 2:1614 GUNBARREL RD SUITE 101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-8345
Mailing Address - Country:US
Mailing Address - Phone:423-553-7600
Mailing Address - Fax:
Practice Address - Street 1:1614 GUNBARREL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-553-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21693207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79365Medicare UPIN
TN3082165Medicare ID - Type Unspecified