Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 51931 | TN |
NPI | 1841532819 |
---|---|
Provider Name | Drew Steven Blackstock |
First Address | Bartlett, TN 38134-2875 |
Second Address | Bartlett, TN 38134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2013 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02237563 | (05) | MS |
1841532819 | (05) | MO |
Q008983 | (05) | TN |