Christopher Douglas Blazina, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

P2642 Issued in TN

Practice address

6110 Shallowford Rd
C O CRC
Chattanooga, TN 37421-1615

Phone

(800) 632-6074

Fax

(866) 341-7509

NPI assigned

Jun 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wildwoods Counseling LLC

  • Psychologist
  • Sandia Park, NM
  • NPI 1700651650
  NPD Authorized official
• Tennessee TMS Center, PLLC

  • Psychiatry Physician
  • Nashville, TN
  • NPI 1649637133
  NPD (past)

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1275569774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "963 MOUNTAIN VALLEY DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372095157",
            "telephone_number": "615-500-8574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6110 SHALLOWFORD RD",
            "address_2": "C O CRC",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374211615",
            "telephone_number": "800-632-6074",
            "fax_number": "866-341-7509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAZINA",
        "first_name": "CHRISTOPHER",
        "middle_name": "DOUGLAS",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-25",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "P2642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3585928",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randy R. Blankenship, D.PH.
• Rachel Blanton, NCC
• Tara Lynne Blanton
• Taylor D Blaylock, DMD
• Azra Blazevic, NP
• Stephanie Renee Bledsoe, CPHT
• Adeline Autumn Blessing-Loggins, RBT
• Amanda Blevins
• Gary A Blinn, CRNA
• Justin Blinn, M.D.

• Psychologist in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.