Individual
GERALD G BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2050 MEADOWVIEW PARKWAY, KINGSPORT, TN 37660-7332
(423) 230-5000
(423) 230-5097
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
27170
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060034463
—
KY
05
—
3094989
—
TN
05
—
5836361
—
VA
01
—
621112685
UNITED HEALTH CARE
TN
Enumeration date
06/23/2006
Last updated
12/03/2014
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