Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS0000007949 | TN |
NPI | 1003889874 |
---|---|
Provider Name | Dr. James Mickael Blaney |
First Address | Goodlettsville, TN 37072-2304 |
Second Address | Goodlettsville, TN 37072-2304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 08/07/2007 |