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General NPI Number Information
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NPI Number | 1851480396
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Entity Type | Individual
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Provider Name | BENJAMIN B BLACKMON JR. MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 109 BLARNEY DR
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City | COLUMBIA
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State | SC
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Zip | 29223-6244
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Country | US
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Telephone | 803-865-8200
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Fax | 803-419-7910
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Provider Business Mailing Address
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Address Line | 1117 GLENWOOD CT
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City | COLUMBIA
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State | SC
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Zip | 29204-3361
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Country | US
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Telephone | 803-467-4171
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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 | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 10460
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 10460
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 10460
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License Number State | SC
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