| Dr Sumpter D Blackmon PA | |
|
321 Whiskey Run Rd Camden AL 36726-2303 | |
| (334) 682-4128 | |
| (334) 682-9151 |
| Full Name | Dr Sumpter D Blackmon PA |
|---|---|
| Speciality | Clinic/center |
| Location | 321 Whiskey Run Rd, Camden, Alabama |
| Authorized Official Name and Position | Sumpter Dudley Blackmon (PRESIDENT) |
| Authorized Official Contact | 3346824128 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Sumpter D Blackmon PA Po Box 699 Camden AL 36726-0699 Ph: (334) 682-4128 | Dr Sumpter D Blackmon PA 321 Whiskey Run Rd Camden AL 36726-2303 Ph: (334) 682-4128 |
| NPI Number | 1720153539 |
|---|---|
| Provider Enumeration Date | 11/21/2006 |
| Last Update Date | 02/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720153539 | NPI | - | NPPES |
| 000000454 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 5754 (Alabama) | Primary |
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