Healthcare Provider Details

I. General information

NPI: 1801718689
Provider Name (Legal Business Name): CHANNING CHRISTINA BLACKMON PERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 FOOTHILLS PKWY
CHELSEA AL
35043-8179
US

IV. Provider business mailing address

115 W CLAY ST
SYLACAUGA AL
35150-3413
US

V. Phone/Fax

Practice location:
  • Phone: 205-678-0861
  • Fax:
Mailing address:
  • Phone: 256-245-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-171110
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: