Individual
MARY OLIVIA BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
800 LAKESHORE DR, BIRMINGHAM, AL 35229-0001
(205) 726-4472
Mailing address
547 LEGRAND PL, MONTGOMERY, AL 36106-1825
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
T34014
AL
Other
Enumeration date
05/08/2013
Last updated
05/08/2013
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