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General NPI Number Information
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NPI Number | 1487605366
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Entity Type | Individual
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Provider Name | BLAKE P MELLING MD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 4138 DURHAM LNDG
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City | MORRISTOWN
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State | TN
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Zip | 37813-1006
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Country | US
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Telephone | 423-586-1717
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Fax | 423-586-1763
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Provider Business Mailing Address
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Address Line | 4138 DURHAM LNDG
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City | MORRISTOWN
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State | TN
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Zip | 37813-1006
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Country | US
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Telephone | 423-586-1717
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Fax | 423-586-1763
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD37751
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License Number State | TN
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