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General NPI Number Information
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NPI Number | 1245486505
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Entity Type | Organization
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Legal Business Name | BLACKBELT CLINIC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 1302 NORTH WASHINGTON
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City | LIVINGSTON
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State | AL
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Zip | 35470-0000
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Country | US
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Telephone | 205-652-2070
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Fax | 205-652-2071
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Provider Business Mailing Address
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Address Line | 1302 NORTH WASHINGTON
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City | LIVINGSTON
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State | AL
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Zip | 35470-0000
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Country | US
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Telephone | 205-652-2070
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Fax | 205-652-2071
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Authorized Official
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Title or Position | OWNER
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Name | ERIK PAUL LESSMANN
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Credential | M.D.
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Telephone | 205-652-2070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25980
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License Number State | AL
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