Healthcare Provider Details

I. General information

NPI: 1851096267
Provider Name (Legal Business Name): FAITH BLACKMON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7693 RHEA COUNTY HWY STE 1
DAYTON TN
37321-6083
US

IV. Provider business mailing address

7693 RHEA COUNTY HWY STE 1
DAYTON TN
37321-6083
US

V. Phone/Fax

Practice location:
  • Phone: 423-594-8700
  • Fax:
Mailing address:
  • Phone: 423-594-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6783
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: