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General NPI Number Information
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NPI Number | 1720153539
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Entity Type | Organization
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Legal Business Name | DR SUMPTER D BLACKMON PA
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 321 WHISKEY RUN RD
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City | CAMDEN
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State | AL
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Zip | 36726-2303
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Country | US
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Telephone | 334-682-4128
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Fax | 334-682-9151
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Provider Business Mailing Address
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Address Line | PO BOX 699
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City | CAMDEN
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State | AL
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Zip | 36726-0699
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Country | US
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Telephone | 334-682-4128
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Fax | 334-682-9151
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUMPTER DUDLEY BLACKMON
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Credential | M.D.
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Telephone | 334-682-4128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5754
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License Number State | AL
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