Provider Demographics
NPI:1912922428
Name:BLANKENSHIP, CARL S (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:S
Last Name:BLANKENSHIP
Suffix:
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 1:1219 MCGAVOCK ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-3129
Mailing Address - Country:US
Mailing Address - Phone:615-750-2869
Mailing Address - Fax:
Practice Address - Street 1:1219 MCGAVOCK ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-3129
Practice Address - Country:US
Practice Address - Phone:615-750-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31850261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051513287OtherBLUECROSS
AL051513287Medicaid
AL051513287OtherBLUECROSS
AL051513287Medicaid