Individual
DR. JERRY D BLAYLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 S CHURCH ST, JONESBORO, AR 72401-4105
(870) 935-0360
(870) 972-8603
Mailing address
901 S CHURCH ST, JONESBORO, AR 72401-4105
(870) 935-0360
(870) 972-8603
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C4264
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101644001
—
AR
Enumeration date
07/04/2006
Last updated
09/22/2011
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