Healthcare Provider Details

I. General information

NPI: 1275649519
Provider Name (Legal Business Name): BLOUNT ORTHOPAEDIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 LAUREL AVE SUITE 402 NEWLAND PROFESSIONAL BLDG.
KNOXVILLE TN
37916-1810
US

IV. Provider business mailing address

2001 LAUREL AVE SUITE 402 NEWLAND PROFESSIONAL BLDG.
KNOXVILLE TN
37916-1810
US

V. Phone/Fax

Practice location:
  • Phone: 865-632-5577
  • Fax: 865-632-5584
Mailing address:
  • Phone: 865-632-5577
  • Fax: 865-632-5584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number15337
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number37760
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24287
License Number StateTN

VIII. Authorized Official

Name: MS. TAMMY C BEARDSLEY-RAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 865-549-4857