Individual
BRENT BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2700 10TH AVE S, STE 200, BIRMINGHAM, AL 35205-1200
(205) 938-7838
(205) 683-2468
Mailing address
4333 BENT RIVER PKWY, HOOVER, AL 35216-5313
(205) 420-3565
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
AL
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
12/15/2015
Last updated
09/27/2023
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