Provider Demographics
NPI:1093846719
Name:JAMES J. BLOUNT, III, MD
Entity Type:Organization
Organization Name:JAMES J. BLOUNT, III, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:601-798-1512
Mailing Address - Street 1:517 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3203
Mailing Address - Country:US
Mailing Address - Phone:601-798-1512
Mailing Address - Fax:601-798-0448
Practice Address - Street 1:517 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3203
Practice Address - Country:US
Practice Address - Phone:601-798-1512
Practice Address - Fax:601-798-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15547207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1979694Medicaid
MS0118379Medicaid
LA1979694Medicaid
MS0118379Medicaid