Brent Blackwell
Physician Assistant in Birmingham, AL. Individual provider (NPI-1).
NPI number1194180331
StatusActive
Last updated in NPPESSep 27, 2023
Details
- NPI
- 1194180331
- Entity type
- Individual (NPI-1)
- Name
- Brent Blackwell
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 15, 2015
- Certification date
- Sep 27, 2023
- Last updated
- Sep 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | AL | Yes |
| 363AM0700X | Physician Assistant, Medical | – | – | |
| 363AS0400X | Physician Assistant, Surgical | – | – |
Practice location
2700 10th Ave SSte 200
Birmingham, AL 35205-1200
Phone 205-938-7838 · Fax 205-683-2468
Mailing address
4333 Bent River PkwyHoover, AL 35216-5313
Phone 205-420-3565
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