Provider Demographics
NPI:1922715804
Name:BLALOCK, JAMES COREY
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:COREY
Last Name:BLALOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1976 GADSDEN HWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3266
Mailing Address - Country:US
Mailing Address - Phone:205-635-5373
Mailing Address - Fax:
Practice Address - Street 1:1976 GADSDEN HWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3266
Practice Address - Country:US
Practice Address - Phone:205-635-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician