Basic Information
| Provider Information | |||||||||
| NPI: | 1104935063 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLACKMON | ||||||||
| FirstName: | SAMER | ||||||||
| MiddleName: | BEDI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 HIGHWAY 34 E | ||||||||
| Address2: | PIEDMONT PHYSICANS AT WHITE OAK | ||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302651325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702526767 | ||||||||
| FaxNumber: | 4046142004 | ||||||||
| Practice Location | |||||||||
| Address1: | 1825 HIGHWAY 34 E | ||||||||
| Address2: | ST. 3000 | ||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302651325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702526767 | ||||||||
| FaxNumber: | 4045645902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME98265 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 279337700 | 05 | FL | MEDICAID |