Provider Demographics
NPI:1164408464
Name:BLOUNT, EMMETT III (IDHS)
Entity Type:Individual
Prefix:
First Name:EMMETT
Middle Name:
Last Name:BLOUNT
Suffix:III
Gender:M
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 SHOTGUN RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4505
Mailing Address - Country:US
Mailing Address - Phone:757-421-1800
Mailing Address - Fax:
Practice Address - Street 1:1317 BALLAHACK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-2499
Practice Address - Country:US
Practice Address - Phone:757-421-8220
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Not Answered1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians