Provider Demographics
NPI:1689907784
Name:BLACKWELL, BILLY R (M D)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:R
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 SANTEE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5737
Mailing Address - Country:US
Mailing Address - Phone:843-669-0423
Mailing Address - Fax:
Practice Address - Street 1:907 SANTEE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5737
Practice Address - Country:US
Practice Address - Phone:843-669-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4914171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty