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General NPI Number Information
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NPI Number | 1144286709
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Entity Type | Organization
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Legal Business Name | BLOUNT GASTROENTEROLOGY ASSOC PC
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 1706 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-6204
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Country | US
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Telephone | 865-983-0073
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Fax | 865-984-1731
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Provider Business Mailing Address
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Address Line | 1706 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-6204
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Country | US
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Telephone | 865-983-0073
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Fax | 865-984-1731
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Authorized Official
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Title or Position | PRESIDENT
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Name | STUART CRAIG JARVIS
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Credential | MD
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Telephone | 865-983-0073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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