1215245931 NPI number — MRS. MEGGAN HANSON BLAYLOCK MS

Table of content: MRS. MEGGAN HANSON BLAYLOCK MS (NPI 1215245931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215245931 NPI number — MRS. MEGGAN HANSON BLAYLOCK MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAYLOCK
Provider First Name:
MEGGAN
Provider Middle Name:
HANSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARCLAY
Provider Other First Name:
MEGGAN
Provider Other Middle Name:
HANSON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215245931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
372 GREENO RD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRHOPE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36532-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-990-4190
Provider Business Mailing Address Fax Number:
251-928-0126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655-5327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-234-7601
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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