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General NPI Number Information
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NPI Number | 1437528148
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Entity Type | Individual
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Provider Name | BRADLEY JACOB BLAIR BSN, RN, CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 907 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-5015
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Country | US
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Telephone | 865-380-9070
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Fax | 865-380-9093
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Provider Business Mailing Address
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Address Line | PO BOX 24776
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City | CHATTANOOGA
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State | TN
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Zip | 37422-4776
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Country | US
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Telephone | 877-288-1799
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Fax | 855-917-2023
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 180244
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License Number State | TN
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