NPIMap

Organization Active NPI

Dr Sumpter D Blackmon PA

  • Clinic/Center
  • Camden, AL
National Provider Identifier
1720153539
Registry record updated Feb 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
5754 Issued in AL
Legal business name
DR SUMPTER D BLACKMON PA
Practice address
321 Whiskey Run Rd
Camden, AL 36726-2303
Phone
(334) 682-4128
Fax
(334) 682-9151
NPI assigned
Nov 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sumpter Dudley Blackmon, M.D.
Title
President
Phone
(334) 682-4128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 5754 AL Primary

Addresses

Primary practice location

321 Whiskey Run Rd
Camden, AL 36726-2303

Mailing address

PO Box 699
Camden, AL 36726-0699
Phone (334) 682-4128

Other identifiers 1

IdentifierTypeStateIssuer
000000454MedicaidAL

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265068800000",
    "number": "1720153539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "CAMDEN",
            "state": "AL",
            "postal_code": "367260699",
            "telephone_number": "334-682-4128",
            "fax_number": "334-682-9151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 WHISKEY RUN RD",
            "city": "CAMDEN",
            "state": "AL",
            "postal_code": "367262303",
            "telephone_number": "334-682-4128",
            "fax_number": "334-682-9151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR SUMPTER D BLACKMON PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2010-02-02",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "SUMPTER",
        "authorized_official_middle_name": "DUDLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "334-682-4128",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AL",
            "license": "5754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000454",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.