Provider Demographics
NPI:1063608966
Name:ERIC BLAKNEY
Entity type:Organization
Organization Name:ERIC BLAKNEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLAKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-756-6991
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 323B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-756-6991
Mailing Address - Fax:901-756-6908
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 323B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-756-6991
Practice Address - Fax:901-756-6908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4108654OtherBLUECROSS BLUESHIELD
TN=========OtherUNITED HEALTH CARE
TN=========OtherNALC
TN=========OtherPRINCIPAL LIFE INSURANCE
TN=========OtherHUMANA
TN=========OtherJ.P. FARLEY
TN4108654OtherBLUECROSS BLUESHIELD
TN=========OtherAETNA
TN=========OtherCHAMPVA
TN=========OtherCIGNA
TN=========OtherPRINCIPAL LIFE INSURANCE