Provider Demographics
NPI:1104935063
Name:BLACKMON, SAMER BEDI (MD)
Entity type:Individual
Prefix:DR
First Name:SAMER
Middle Name:BEDI
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1615 HIGHWAY 34 E
Mailing Address - Street 2:PIEDMONT PHYSICANS AT WHITE OAK
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1325
Mailing Address - Country:US
Mailing Address - Phone:770-252-6767
Mailing Address - Fax:404-614-2004
Practice Address - Street 1:1825 HIGHWAY 34 E
Practice Address - Street 2:ST. 3000
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1325
Practice Address - Country:US
Practice Address - Phone:770-252-6767
Practice Address - Fax:404-564-5902
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME98265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279337700Medicaid
FL279337700Medicaid
FLAG157ZMedicare PIN