# DR SUMPTER D BLACKMON PA

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

## Provider details

- **NPI number:** 1720153539
- **Authorized official:** DR. SUMPTER DUDLEY BLACKMON M.D. (PRESIDENT)
- **Authorized official phone:** (334) 682-4128

## Contact information

- **Practice address:** 321 WHISKEY RUN RD, CAMDEN, AL 36726-2303
- **Practice address phone:** (334) 682-4128
- **Practice address fax:** (334) 682-9151
- **Mailing address:** PO BOX 699, CAMDEN, AL 36726-0699
- **Mailing address phone:** (334) 682-4128
- **Mailing address fax:** (334) 682-9151

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 5754 | AL | Yes |

## Other

- **Enumeration date:** 11/21/2006
- **Last updated:** 02/02/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000000454 | — | AL |