Provider Demographics
NPI:1417190885
Name:BLACKWELL, DANNY REESE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:REESE
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N MATSON ST
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-1216
Mailing Address - Country:US
Mailing Address - Phone:803-475-6835
Mailing Address - Fax:803-475-5715
Practice Address - Street 1:116 N MATSON ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1216
Practice Address - Country:US
Practice Address - Phone:803-475-6835
Practice Address - Fax:803-475-5715
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4147174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist