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General NPI Number Information
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NPI Number | 1275842320
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Entity Type | Organization
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Legal Business Name | BLOUNT NEUROLOGY LLC
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 1131 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-5130
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Country | US
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Telephone | 865-981-2080
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Fax | 865-981-2081
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Provider Business Mailing Address
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Address Line | 1131 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-5130
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Country | US
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Telephone | 865-981-2080
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Fax | 865-981-2081
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Authorized Official
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Title or Position | OWNER
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Name | THEA J CROSS
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Credential | MD
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Telephone | 865-981-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 37389
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License Number State | TN
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