Healthcare Provider Details

I. General information

NPI: 1629290689
Provider Name (Legal Business Name): JOHN EVERETT BLAKE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 N. LYERLY ST. SUITE 200
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

281 N LYERLY ST STE 200
CHATTANOOGA TN
37404-2749
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-0850
  • Fax: 423-698-0511
Mailing address:
  • Phone: 423-698-0850
  • Fax: 833-450-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD44681
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD26794
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number26794
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: