MEDICARE: WILLIAM BLAYLOCK BURKHART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	65334	TN

General Provider Information

NPI Number	:	1003377573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BLAYLOCK BURKHART MD

Provider Business Mailing Address
First Line	:	8848 CEDAR SPRINGS LN STE 201
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-5416
Country	:	US
Telephone Number	:	865-540-6857
Fax Number	:	865-401-3865

Provider Business Practice Location Address
First Line	:	8848 CEDAR SPRINGS LN STE 201
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-5416
Country	:	US
Telephone Number	:	865-540-3865
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	09/22/2023

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