Victor Joseph Hubert Blackett, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

50256 Issued in TN

Practice address

677 Granwood Blvd
Old Hickory, TN 37138-4243

Phone

(615) 336-2242

NPI assigned

Mar 29, 2011

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1063701100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "677 GRANWOOD BLVD",
            "city": "OLD HICKORY",
            "state": "TN",
            "postal_code": "371384243",
            "telephone_number": "615-336-2242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 GRANWOOD BLVD",
            "city": "OLD HICKORY",
            "state": "TN",
            "postal_code": "371384243",
            "telephone_number": "615-336-2242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "294 Summar Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "TN",
            "postal_code": "383013915",
            "country_code": "US",
            "telephone_number": "731-423-1932 x323",
            "fax_number": "731-410-0367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKETT",
        "first_name": "VICTOR",
        "middle_name": "JOSEPH HUBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-29",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TN",
            "license": "50256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashia Banks
• Celesta Rhea Bargatze, CPM-TN
• Theodore Henry Bartoshesky, PTA
• Ashley Robeson Beziat, PHARMD
• Autumn Tenae Blackburn, D.C.
• Kimberly Boyd
• Bradshaw Chiropractic PLLC
• Kevin Bradshaw, D.C.
• Kia Brewer, LMSW
• Diane Maria Campbell, DNP,FNP- BC

• General Practice Physician in Old Hickory, TN
• Providers in Old Hickory, TN by specialty
• General Practice Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.