Jeremy Ty Blackwell, M.D.
Family Medicine in Jasper, AL. Individual provider (NPI-1).
NPI number1205053352
StatusActive
Last updated in NPPESFeb 1, 2013
Details
- NPI
- 1205053352
- Entity type
- Individual (NPI-1)
- Name
- Jeremy Ty Blackwell
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 19, 2007
- Last updated
- Feb 1, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 27715 | AL | Yes |
Practice location
1450 Jones Dairy RoadBldg 900
Jasper, AL 35501-6108
Phone 205-387-8159 · Fax 205-387-8262
Mailing address
1450 Jones Dairy RoadBldg 600
Jasper, AL 35501-6109
Phone 205-387-8159 · Fax 205-387-8262
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