Healthcare Provider Details

I. General information

NPI: 1689665903
Provider Name (Legal Business Name): JOSEPH A BLYTHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3557 S GALLOWAY DR
MEMPHIS TN
38111-6816
US

IV. Provider business mailing address

3557 S GALLOWAY DR
MEMPHIS TN
38111-6816
US

V. Phone/Fax

Practice location:
  • Phone: 901-371-6666
  • Fax: 901-324-6355
Mailing address:
  • Phone: 901-371-6666
  • Fax: 901-324-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number7632
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number7632
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: