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General NPI Number Information
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NPI Number | 1659683266
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Entity Type | Individual
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Provider Name | DOUGLAS HUNT BLACKLEDGE D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 950 MATTHEW DR
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City | WAYNESBORO
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State | MS
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Zip | 39367-2567
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Country | US
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Telephone | 601-735-7246
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Fax | 601-735-7245
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Provider Business Mailing Address
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Address Line | 103 BRECKENRIDGE DR
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City | WAYNESBORO
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State | MS
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Zip | 39367-3134
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Country | US
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Telephone | 601-671-1155
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | T-2288
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 23160
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License Number State | MS
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