Healthcare Provider Details

I. General information

NPI: 1831136175
Provider Name (Legal Business Name): PHILIP J BLOUNT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 E WOODROW WILSON AVE
JACKSON MS
39216-5114
US

IV. Provider business mailing address

1350 EAST WOODROW WILSON DR. METHODIST REHABILITATION CENTER
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-8801
  • Fax: 601-936-8808
Mailing address:
  • Phone: 601-936-8801
  • Fax: 601-936-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number18478
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: