Basic Information
| Provider Information | |||||||||
| NPI: | 1992793897 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOUNT | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 HIGHLAND PKWY | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PICAYUNE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394665577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017983989 | ||||||||
| FaxNumber: | 6017985914 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 HIGHLAND PKWY | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PICAYUNE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394665577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017983989 | ||||||||
| FaxNumber: | 6017985914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 12/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 15547 | MS | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0118379 | 05 | MS | MEDICAID | 1979694 | 05 | LA | MEDICAID |