Healthcare Provider Details

I. General information

NPI: 1811190804
Provider Name (Legal Business Name): ANGELA CATO BLOUNT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E SUITE 205
JASPER AL
35501-8950
US

IV. Provider business mailing address

833 SAINT VINCENTS DR SUITE 402
BIRMINGHAM AL
35205-1606
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-4630
  • Fax: 205-221-4731
Mailing address:
  • Phone: 205-933-9236
  • Fax: 205-933-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number29217
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: