Healthcare Provider Details

I. General information

NPI: 1912909508
Provider Name (Legal Business Name): ERIC D BLAKNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE STE 200
MEMPHIS TN
38119-5212
US

IV. Provider business mailing address

PO BOX 22403
BELFAST ME
04915-4476
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-2100
  • Fax: 901-761-1442
Mailing address:
  • Phone: 888-402-7256
  • Fax: 888-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number21896
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number218961
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30789
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: