Blackmon, Demetrious J.
Blackmon, Demetrious J. is an individual health care provider with primary practice located at 250 Village Center Pwky Suite 100, Stockbridge GA 30281-9044. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Nephrology. Allopathic & Osteopathic Physicians / Nephrology is his primary health care specialty. Blackmon, Demetrious J. can be contacted via phone (678) 289-0508.Contact Information
Primary practice address
250 Village Center Pwky Suite 100
Stockbridge GA 30281-9044
Phone: (678) 289-0508
Fax: (678) 289-0124
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD38696 | Tennessee |
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | 57778 | Georgia |
Profile Details
| NPI number | 1578592994 |
|---|---|
| LBN Legal business name | Blackmon, Demetrious J. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 30th, 2006 |
| Last updated | Mar 4th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578592994 | NPPES |
| Alabama | MEDICAID | 009934159 | |
| Alabama | MEDICAID | 662769049A | |
| Alabama | Other | P00254515 | |
| Alabama | MEDICAID | 3334458 | |
| Alabama | Other | 4111806 | |
| Alabama | MEDICAID | 662769049F | |
| Alabama | MEDICAID | 3334459 | |
| Alabama | Other | 581365705 | |
| Alabama | Other | 4152444 |
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