MEDICARE: JOHN EVERETT BLAKE III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	MD44681	TN
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD44681	TN
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD26794	AL
4	207L00000X	Anesthesiology Physician	26794	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629290689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN EVERETT BLAKE III MD

Provider Business Mailing Address
First Line	:	281 N LYERLY ST STE 200
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404-2749
Country	:	US
Telephone Number	:	423-698-0850
Fax Number	:	833-450-6211

Provider Business Practice Location Address
First Line	:	281 N. LYERLY ST.
Second Line	:	SUITE 200
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404
Country	:	US
Telephone Number	:	423-698-0850
Fax Number	:	423-698-0511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	01/14/2026

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Directions to “ JOHN EVERETT BLAKE III MD” Practice Location

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