1679542575 NPI number — MRS. JAMIE MORGAN BLACKWELDER ENP

Table of content: MRS. JAMIE MORGAN BLACKWELDER ENP (NPI 1679542575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679542575 NPI number — MRS. JAMIE MORGAN BLACKWELDER ENP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACKWELDER
Provider First Name:
JAMIE
Provider Middle Name:
MORGAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ENP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN
Provider Other First Name:
JAMIE
Provider Other Middle Name:
THOMAS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ENP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679542575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 JAMIE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27019-9157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-994-4005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
J R JONES MEDICAL CENTER
Provider Second Line Business Practice Location Address:
402 WEST KING ST
Provider Business Practice Location Address City Name:
KING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-983-9617
Provider Business Practice Location Address Fax Number:
336-983-9791
Provider Enumeration Date:
03/15/2006

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: 363L00000X , with the licence number:  700003 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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