Provider Demographics
NPI:1003444993
Name:BLAIR, JAMMIE (CRNP)
Entity Type:Individual
Prefix:
First Name:JAMMIE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 DRAKE AVE SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1042
Mailing Address - Country:US
Mailing Address - Phone:256-603-5155
Mailing Address - Fax:
Practice Address - Street 1:701 19TH ST S # ST112
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1926
Practice Address - Country:US
Practice Address - Phone:205-934-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069315204F00000X, 2086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery