Blalock, William Tate

Blalock, William Tate is an individual health care provider with primary practice located at Dogwood Ave Quillen Veterans Affairs Medical Center -Bldg 204, Mountain Home TN 37684-4000. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Blalock, William Tate can be contacted via phone (423) 979-3497.

Contact Information

Primary practice address
Dogwood Ave Quillen Veterans Affairs Medical Center -Bldg 204 Mountain Home TN 37684-4000
Phone: (423) 979-3497
Fax: (423) 979-2894
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 409 Tennessee

Profile Details

NPI number 1134148638
LBN Legal business name Blalock, William Tate
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2006
Last updated Jan 28th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134148638 NPPES
Virginia MEDICAID 8923647

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