Provider Demographics
NPI:1992047187
Name:BLANTON, SEAN MARTIN (PA)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MARTIN
Last Name:BLANTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 PARK WEST BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4330
Mailing Address - Country:US
Mailing Address - Phone:865-694-0577
Mailing Address - Fax:
Practice Address - Street 1:9314 PARK WEST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4330
Practice Address - Country:US
Practice Address - Phone:865-694-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant