Provider Demographics
NPI:1669077038
Name:BLACKWELL FAMILY FOOT CARE
Entity type:Organization
Organization Name:BLACKWELL FAMILY FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:601-449-0192
Mailing Address - Street 1:1815 HOSPITAL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3425
Mailing Address - Country:US
Mailing Address - Phone:601-449-0192
Mailing Address - Fax:601-449-0194
Practice Address - Street 1:1815 HOSPITAL DR STE 301
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3425
Practice Address - Country:US
Practice Address - Phone:601-449-0192
Practice Address - Fax:601-449-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty