Healthcare Provider Details

I. General information

NPI: 1669919650
Provider Name (Legal Business Name): DR JAMES H BLANTON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4453 FREDERICKSBURG CIR
MOUNTAIN BRK AL
35213-1817
US

IV. Provider business mailing address

PO BOX 530604
BIRMINGHAM AL
35253-0604
US

V. Phone/Fax

Practice location:
  • Phone: 205-879-8294
  • Fax: 205-879-8259
Mailing address:
  • Phone: 205-879-8294
  • Fax: 205-879-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: JAMES H BLANTON
Title or Position: OWNER
Credential: MD
Phone: 205-901-0199