Individual
LAURA JOHNETTA BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5653 FRIST BLVD, SUITE 434, HERMITAGE, TN 37076-2062
(615) 871-9996
(615) 871-9661
Mailing address
PO BOX 440100, NASHVILLE, TN 37244-0100
(615) 871-9996
(615) 871-9661
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
38475
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4087020
BCBS TN
TN
01
—
7820270
AETNA
TN
01
—
99620
BCBS AR
AR
Enumeration date
07/07/2006
Last updated
02/27/2012
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