Provider Demographics
NPI:1720531577
Name:BLACKWELL, JAMES MADISON (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MADISON
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:3480 KEITH BRIDGE RD
Practice Address - Street 2:STE C2
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5568
Practice Address - Country:US
Practice Address - Phone:678-455-8773
Practice Address - Fax:678-455-8775
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist