Provider Demographics
NPI:1679795538
Name:BLOUNT, KEVIN J (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2722 MERRILEE DR
Mailing Address - Street 2:STE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4400
Mailing Address - Country:US
Mailing Address - Phone:703-698-4444
Mailing Address - Fax:703-204-0116
Practice Address - Street 1:790 CHURCH ST NE
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7282
Practice Address - Country:US
Practice Address - Phone:770-952-8899
Practice Address - Fax:678-581-3680
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2018-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0116016844390200000X
CT0474192085R0202X
GA0759622085R0202X
VA01012374792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program