Provider Demographics
NPI:1528495140
Name:BLANTON, PAMELA KAYE
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KAYE
Last Name:BLANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 DEER POINT RD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37180-2004
Mailing Address - Country:US
Mailing Address - Phone:931-639-3803
Mailing Address - Fax:
Practice Address - Street 1:2122 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4430
Practice Address - Country:US
Practice Address - Phone:931-490-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness