Blackwood, Kimathi Sipho Ricardo
Blackwood, Kimathi Sipho Ricardo is an individual health care provider with primary practice located at 890 Second Street Suite 201, Macon GA 31201-6863. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Nephrology. Allopathic & Osteopathic Physicians / Nephrology is his primary health care specialty. Blackwood, Kimathi Sipho Ricardo can be contacted via phone (478) 745-4322.Contact Information
Primary practice address
890 Second Street Suite 201
Macon GA 31201-6863
Phone: (478) 745-4322
Fax: (478) 750-8789
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | 063834 | Georgia |
Profile Details
| NPI number | 1609071448 |
|---|---|
| LBN Legal business name | Blackwood, Kimathi Sipho Ricardo |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 20th, 2007 |
| Last updated | Jun 21st, 2022 - about 2 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 | 1609071448 | NPPES |
| Georgia | MEDICAID | 546478200BB | |
| Georgia | MEDICAID | 546478200C |
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