Healthcare Provider Details
I. General information
NPI: 1730017351
Provider Name (Legal Business Name): BLOUNT DERMATOLOGY SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
255 E WATT ST STE 247
ALCOA TN
37701-2236
US
IV. Provider business mailing address
257 N CALDERWOOD ST PMB 394
ALCOA TN
37701
US
V. Phone/Fax
- Phone: 630-918-6947
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207NS0135X |
| Taxonomy | Procedural Dermatology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207N00000X |
| Taxonomy | Dermatology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
KEVIN
VEVERKA
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 865-351-0433