Healthcare Provider Details

I. General information

NPI: 1992793897
Provider Name (Legal Business Name): JAMES J BLOUNT III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 HIGHLAND PKWY SUITE 202
PICAYUNE MS
39466-5577
US

IV. Provider business mailing address

128 HIGHLAND PKWY SUITE 202
PICAYUNE MS
39466-5577
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-3989
  • Fax: 601-798-5914
Mailing address:
  • Phone: 601-798-3989
  • Fax: 601-798-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15547
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: