Blackmon, Micah Shawn
Blackmon, Micah Shawn is an individual health care provider with primary practice located at 775 Poplar Rd Suite 160, Newnan GA 30265-8300. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Blackmon, Micah Shawn can be contacted via phone (770) 400-4630.Contact Information
Primary practice address
775 Poplar Rd Suite 160
Newnan GA 30265-8300
Phone: (770) 400-4630
Fax: (770) 254-6069
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | 059045 | Georgia |
Profile Details
| NPI number | 1588876411 |
|---|---|
| LBN Legal business name | Blackmon, Micah Shawn |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 4th, 2007 |
| Last updated | Oct 2nd, 2014 - about 10 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 | 1588876411 | NPPES |
| Georgia | Other | 202I348220 | MEDICARE PTAN |
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