Active NPI
Alvin Blackmon III, PHARMD
- Nuclear Pharmacist
- Fort Gordon, GA
National Provider Identifier
1104125095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nuclear Pharmacist
- License
- 0202205702
- Practice address
- 300 W Hospital Rd
Fort Gordon, GA 30905-5741 - Phone
- (706) 787-7763
- NPI assigned
- Mar 18, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Pharmacist | 1835N0905X | 0202205702 | VA | Primary |
| Nuclear Pharmacist | 1835N0905X | 017025 | LA |
Addresses
Primary practice location
300 W Hospital Rd
Fort Gordon, GA 30905-5741
Mailing address
300 W Hospital Rd
Fort Gordon, GA 30905-5741
Phone (706) 787-7763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017025 | LA | MD | Nuclear Pharmacist |
| 0202205702 | VA | MD | Nuclear Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300406400000",
"number": "1104125095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W HOSPITAL RD",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309055741",
"telephone_number": "706-787-7763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W HOSPITAL RD",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309055741",
"telephone_number": "706-787-7763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKMON",
"first_name": "ALVIN",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-18",
"last_updated": "2011-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "1835N0905X",
"taxonomy_group": "",
"desc": "Pharmacist, Nuclear",
"state": "VA",
"license": "0202205702",
"primary": true
},
{
"code": "1835N0905X",
"taxonomy_group": "",
"desc": "Pharmacist, Nuclear",
"state": "LA",
"license": "017025",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.