Individual
BILLY JACOB BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
154 ROSEMONT ST, SAINT SIMONS ISLAND, GA 31522-1777
(912) 580-8162
Mailing address
154 ROSEMONT ST, SAINT SIMONS ISLAND, GA 31522-1777
(912) 580-8162
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
001196
GA
2085R0202X
Diagnostic Radiology Physician
35.094883
OH
2085R0202X
Diagnostic Radiology Physician
DR.0058928
CO
Other
Enumeration date
04/02/2007
Last updated
07/21/2022
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