Individual
DR. DEMETRIOUS J. BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD38696
TN
207RN0300X
Nephrology Physician
Primary
57778
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009934159
—
AL
05
—
3334458
—
TN
05
—
3334459
—
TN
01
—
4111806
BCBS OF TENNESSEE
TN
01
—
4152444
BLUE CROSS
TN
01
—
581365705
CHAMPUS
GA
05
—
662769049A
—
GA
05
—
662769049F
—
GA
01
—
P00254515
RAILROAD MEDICARE
TN
Enumeration date
06/30/2006
Last updated
03/04/2015
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