Healthcare Provider Details

I. General information

NPI: 1669077038
Provider Name (Legal Business Name): BLACKWELL FAMILY FOOT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 HOSPITAL DR STE 301
JACKSON MS
39204-3425
US

IV. Provider business mailing address

1815 HOSPITAL DR STE 301
JACKSON MS
39204-3425
US

V. Phone/Fax

Practice location:
  • Phone: 601-449-0192
  • Fax: 601-449-0194
Mailing address:
  • Phone: 601-449-0192
  • Fax: 601-449-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY DAWN BLACKWELL
Title or Position: PROVIDER
Credential: DPM
Phone: 601-449-0192