Provider Demographics
NPI:1891741567
Name:BLACKMON, LEE ANN (MD)
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
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:PO BOX 11407 DRAWER 1492
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1492
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:SUITE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-9810
Practice Address - Fax:205-939-9949
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.213912084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL115836Medicaid
AL39780OtherBCBS
AL511-03877OtherFEDERAL BC
AL051039780Medicaid
AL511-02194OtherBCBS
AL1891741567OtherTRICARE SOUTH
AL98345OtherBCBS
AL115827Medicaid
AL511-03879OtherFEDERAL BC
AL511-02189OtherBCBS
AL511-03877OtherFEDERAL BC
AL511-03879OtherFEDERAL BC