# JESSE A BLACKMAN, MD, PA

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

## Provider details

- **NPI number:** 1407887862
- **Authorized official:** DR. JESSE A BLACKMAN M.D. (PRESIDENT)
- **Authorized official phone:** (919) 242-5550

## Contact information

- **Practice address:** 109 S. SYCAMORE STREET, FREMONT, NC 27830
- **Practice address phone:** (919) 242-5550
- **Practice address fax:** (919) 242-6428
- **Mailing address:** 109 S. SYCAMORE STREET, P O BOX 878, FREMONT, NC 27830
- **Mailing address phone:** (919) 242-5550
- **Mailing address fax:** (919) 242-6428

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 18609 | NC | Yes |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8916000 | — | NC |