Organization
THOMAS R. BLACKLEDGE, JR., MD, PA
Active
Other names
Medical Center of Magee
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS R. BLACKLEDGE JR. M.D. (MD/OWNER)
(601) 849-1918
Entity
Organization
Contact information
Practice address
800 3RD ST SW, MAGEE, MS 39111-3951
(601) 849-1918
(601) 849-1908
Mailing address
PO BOX 748, MAGEE, MS 39111-0748
(601) 849-1918
(601) 849-1908
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14559
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115523
—
MS
Enumeration date
05/11/2010
Last updated
05/11/2010
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