Dr. Jonathan Ashley Blossom, M.D.
Internal Medicine in Tupelo, MS. Individual provider (NPI-1).
NPI number1407235617
StatusActive
Last updated in NPPESJun 27, 2022
Details
- NPI
- 1407235617
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jonathan Ashley Blossom
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 20, 2015
- Certification date
- Jun 27, 2022
- Last updated
- Jun 27, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | T-2913 | MS | Yes |
Practice location
499 Gloster Creek Vlg Ste A2Tupelo, MS 38801-4749
Phone 662-620-6801 · Fax 662-377-2403
Mailing address
499 Gloster Creek VlgSte A2
Tupelo, MS 38801-4749
Phone 662-620-6800 · Fax 662-620-6950
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