Provider Demographics
NPI:1487626610
Name:BLOUNT, ROXSON PERRY III (CSA)
Entity Type:Individual
Prefix:MR
First Name:ROXSON
Middle Name:PERRY
Last Name:BLOUNT
Suffix:III
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 MAGNOLIA WALK LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4073
Mailing Address - Country:US
Mailing Address - Phone:770-997-8429
Mailing Address - Fax:
Practice Address - Street 1:8409 DUNWOODY PL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-3367
Practice Address - Country:US
Practice Address - Phone:770-594-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZS0410X
VA785246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist