Provider Demographics
NPI:1134213184
Name:BLACKWOOD, ROBERT (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:BLACKWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WINTER STREET
Mailing Address - Street 2:BUILDING C
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904
Mailing Address - Country:US
Mailing Address - Phone:706-855-8866
Mailing Address - Fax:706-860-6358
Practice Address - Street 1:1505 WINTER STREET
Practice Address - Street 2:BUILDING C
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:706-855-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0251062084P0804X
SC147082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F24854Medicare UPIN
26BDBLXMedicare ID - Type Unspecified