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General NPI Number Information
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NPI Number | 1477523090
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Entity Type | Individual
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Provider Name | JAMES WAID BLACKSTONE M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 209 W SPRING ST STE 302
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City | SYLACAUGA
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State | AL
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Zip | 35150-2976
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Country | US
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Telephone | 205-723-0081
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Fax | 250-723-0837
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Provider Business Mailing Address
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Address Line | 209 W SPRING ST STE 302
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City | SYLACAUGA
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State | AL
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Zip | 35150-2976
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Country | US
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Telephone | 205-723-0081
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Fax | 205-723-0837
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 24790
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License Number State | AL
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