Healthcare Provider Details

I. General information

NPI: 1316941040
Provider Name (Legal Business Name): GARY CHRISTOPHER BLOUNT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 RB WILSON DR STE G
HUNTINGDON TN
38344-1734
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 731-986-7400
  • Fax:
Mailing address:
  • Phone: 901-227-3255
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1075
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: