Provider Demographics
NPI:1992793897
Name:BLOUNT, JAMES J III (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:BLOUNT
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:128 HIGHLAND PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-5577
Mailing Address - Country:US
Mailing Address - Phone:601-798-3989
Mailing Address - Fax:601-798-5914
Practice Address - Street 1:128 HIGHLAND PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-5577
Practice Address - Country:US
Practice Address - Phone:601-798-3989
Practice Address - Fax:601-798-5914
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2014-12-11
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Provider Licenses
StateLicense IDTaxonomies
MS15547207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118379Medicaid
LA1979694Medicaid
LA1979694Medicaid
MS160000363Medicare PIN