Individual
AMANDA BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(228) 218-0246
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
T-5140
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
MS
Other
Enumeration date
03/24/2023
Last updated
07/12/2023
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