Provider Demographics
NPI:1992834949
Name:BLACKMON, FLORIECE GRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:FLORIECE
Middle Name:GRAHAM
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 30515
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27833-0515
Mailing Address - Country:US
Mailing Address - Phone:252-752-6101
Mailing Address - Fax:
Practice Address - Street 1:100 EUROPA DR
Practice Address - Street 2:SUITE 417
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2357
Practice Address - Country:US
Practice Address - Phone:919-932-3744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC307662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD25174Medicare UPIN