# J WAID BLACKSTONE, M.D., LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285843888
- **Authorized official:** DR. JAMES WAID BLACKSTONE M.D. (OWNER)
- **Authorized official phone:** (256) 245-5203

## Contact information

- **Practice address:** 210 W SPRING ST, SYLACAUGA, AL 35150-2924
- **Practice address phone:** (256) 245-5203
- **Practice address fax:** (256) 245-5981
- **Mailing address:** 210 W SPRING ST, SYLACAUGA, AL 35150-2924
- **Mailing address phone:** (256) 245-5203
- **Mailing address fax:** (256) 245-5981

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 24790 | AL | Yes |

## Other

- **Enumeration date:** 05/21/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 7514689 | AETNA | AL |