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General NPI Number Information
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NPI Number | 1437790946
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Entity Type | Individual
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Provider Name | ELIZABETH ANN BLAYLOCK RPSGT, RST, CCSH
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Gender | Female
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Dates
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Enumeration Date | 10/05/2019
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 1675 SHELBY OAKS DR N STE 7
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City | MEMPHIS
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State | TN
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Zip | 38134-7430
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Country | US
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Telephone | 991-526-0202
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Fax | 901-526-0300
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Provider Business Mailing Address
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Address Line | 3476 HUNTERFIELD TRL
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City | BARTLETT
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State | TN
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Zip | 38135-3012
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Country | US
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Telephone | 901-461-4761
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Fax | 901-377-4885
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 9
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License Number State | TN
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