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Contact Information

KELLY L BLAIR, PhD
708 W FOREST AVE
JACKSON, TN38301-3901
 Phone: 731-425-4930
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Rehabilitation

103TR0400X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for KELLY L BLAIR · (Male)

NPI # 1891711131
Status Active
Credentials PhD
Entity Individual
Enumeration date 07/13/2006
Last updated 07/31/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • TN License # 1706
Hospital affiliation(s)
  • JACKSON-MADISON COUNTY GENERAL HOSPITAL - (Acute Care)
    620 SKYLINE DRIVE
    JACKSON, TN 38301
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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