Healthcare Provider Details

I. General information

NPI: 1336786383
Provider Name (Legal Business Name): ANDREW LEVI BLYTHE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 FOREST DR STE 5
GRAY TN
37615-8423
US

IV. Provider business mailing address

1326 PAPERMILL POINTE WAY
KNOXVILLE TN
37909-1903
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-3142
  • Fax: 423-794-3184
Mailing address:
  • Phone: 865-243-2136
  • Fax: 865-243-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: