Individual
THOMAS RAYFORD BLACKLEDGE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 THIRD ST SW, MAGEE, MS 39111
(601) 849-1918
Mailing address
800 3RD ST SW, PO BOX 748, MAGEE, MS 39111-3951
(601) 849-1918
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
06/14/2006
Last updated
08/01/2013
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