Provider Demographics
NPI:1578884466
Name:BLACKWELL, ASHLEY DAWN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:DAWN
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:1815 HOSPITAL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3425
Mailing Address - Country:US
Mailing Address - Phone:601-449-0192
Mailing Address - Fax:601-449-0194
Practice Address - Street 1:1815 HOSPITAL DR STE 301
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3425
Practice Address - Country:US
Practice Address - Phone:601-449-0192
Practice Address - Fax:601-449-0194
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2020-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS80214213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery