Healthcare Provider Details

I. General information

NPI: 1790739845
Provider Name (Legal Business Name): BLOUNT PATHOLOGIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-5015
US

IV. Provider business mailing address

907 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-5015
US

V. Phone/Fax

Practice location:
  • Phone: 865-694-6919
  • Fax: 865-694-4339
Mailing address:
  • Phone: 865-694-6919
  • Fax: 865-694-4339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D TEAGUE
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 865-981-2335