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General NPI Number Information
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NPI Number | 1538438270
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Entity Type | Organization
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Legal Business Name | DAVID C BLACKMON,PHD,PSYCH SVC
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 482 JACKSONVILLE DR
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3812
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Country | US
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Telephone | 904-333-3389
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Fax | 904-246-6703
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Provider Business Mailing Address
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Address Line | 482 JACKSONVILLE DR
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID C BLACKMON
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Credential | PHD
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Telephone | 904-333-3389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY4360
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License Number State | FL
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