Individual
DR. JACK THOMAS BLACKWELL JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
415 EISENHOWER DR, STE 6, SAVANNAH, GA 31406-2600
(912) 354-3510
(912) 356-3391
Mailing address
1499 FAIR RD, STATESBORO, GA 30458-1683
(912) 486-1482
(912) 871-2383
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
023908
GA
Other
Enumeration date
11/01/2005
Last updated
06/25/2016
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