Individual
DR. JOHN LEE BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
629 NUCKOLLS RD, BOLIVAR, TN 38008-1599
(731) 658-3388
(731) 658-4079
Mailing address
PO BOX 720, BOLIVAR, TN 38008-0720
(731) 658-3388
(731) 658-4079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36219
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36219
MEDICAL LICENSE
TN
Enumeration date
11/15/2005
Last updated
07/21/2022
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