Individual
JEREMY TY BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1450 JONES DAIRY ROAD, BLDG 900, JASPER, AL 35501-6108
(205) 387-8159
(205) 387-8262
Mailing address
1450 JONES DAIRY ROAD, BLDG 600, JASPER, AL 35501-6109
(205) 387-8159
(205) 387-8262
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27715
AL
Other
Enumeration date
04/19/2007
Last updated
02/01/2013
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