Robert Lee Blackwell III

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

5292 Day Lily Dr
Lakeland, TN 38002-5351

Phone

(901) 389-0205

NPI assigned

Dec 11, 2024

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 11, 2024.

{
    "created_epoch": "1733875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1942017181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5292 DAY LILY DR",
            "city": "LAKELAND",
            "state": "TN",
            "postal_code": "380025351",
            "telephone_number": "901-389-0205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5292 DAY LILY DR",
            "city": "LAKELAND",
            "state": "TN",
            "postal_code": "380025351",
            "telephone_number": "901-389-0205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "ROBERT",
        "middle_name": "LEE",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-11",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurie Lynette Lehuanani Bagwell, FNP-BC
• Emily Grace Bailey, PTA
• Diosdado A Barawid Jr., PT
• Resa Saturday Barawid, P.T.
• Regina Nichols Barker, MS, OTR/L
• Beau J Blanchard, DC
• Brenda Blanton
• Clyde Eric Brown
• Richard Browning
• Aniko Vedette Campbell, FNP

• All providers in Lakeland, TN
• Athletic Trainer in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.