Healthcare Provider Details

I. General information

NPI: 1134193899
Provider Name (Legal Business Name): JOSEPH BLAKE AYERS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 MIDDLE CREEK RD
SEVIERVILLE TN
37862-5047
US

IV. Provider business mailing address

567 EDGEWOOD DR
GATLINBURG TN
37738-4446
US

V. Phone/Fax

Practice location:
  • Phone: 865-429-6538
  • Fax: 865-429-6657
Mailing address:
  • Phone: 865-679-5699
  • Fax: 865-429-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: