Individual
MR. JONATHAN BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
603 WILD GRAPE DR, SAINT MARYS, GA 31558-3619
(912) 573-2940
Mailing address
881 USS JAMES MADISON RD, NAVAL SUBMARINE SUPPORT CENTER MEDICAL DEPARTMENT, KINGS BAY, GA 31547-2531
(912) 573-2940
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
246QM0706X
Medical Technologist
—
—
Other
Enumeration date
06/06/2006
Last updated
08/12/2021
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