Organization
J WAID BLACKSTONE, M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES WAID BLACKSTONE M.D. (OWNER)
(256) 245-5203
Entity
Organization
Contact information
Practice address
210 W SPRING ST, SYLACAUGA, AL 35150-2924
(256) 245-5203
(256) 245-5981
Mailing address
210 W SPRING ST, SYLACAUGA, AL 35150-2924
(256) 245-5203
(256) 245-5981
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
24790
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7514689
AETNA
AL
Enumeration date
05/21/2007
Last updated
08/22/2020
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