BILLY JACOB BLACKMON (NPI# 1215058110) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215058110 |
| Entity Type | Individual |
| Full Name | BILLY JACOB BLACKMON |
| Credential | MD |
| Practice Address |
154 Rosemont St Saint Simons Island GA 31522-1777 |
| Practice Telephone | (912) 580-8162 |
| Mailing Telephone | 9125808162 |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2019-08-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
35.094883 | OH | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
DR.0058928 | CO | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
001196 | GA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 234 Goodman St, Cincinnati, OH 452192364 | 5135847355 | 5135840431 |
| Street Address |
154 ROSEMONT ST |
| City | SAINT SIMONS ISLAND |
| State | GA |
| Zip Code | 31522-1777 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982186342 | Matthew Mackinnon Gibbs | Specialist/Technologist | 211 Village Dr, St Simons Is, GA 31522 | 2018-09-02 |
| 1770957433 | Jennifer Herrin, Lpc | Community/Behavioral Health | 400 Main Street, Cottage 1, Saint Simons Island, GA 31522 | 2015-11-18 |
| 1508113002 | Ashley Neal Callicutt | Counselor | 301 Sea Island Road, Suite G, St. Simons Island, GA 31522 | 2012-08-14 |
| 1235414103 | Dana D'andrea Duggan | Psychologist | 283 Redfern Village, St. Simons Island, GA 31522 | 2011-10-11 |
| 1528394848 | Nancy Hodges Bowen | Nurse Practitioner | 7000 Wellness Way, Suite 130, St. Simons Island, GA 31522 | 2009-10-21 |
| 1073763215 | John Arthur Hendry | Dentist | 511 Mallery Street, St. Simons Island, GA 31522 | 2008-09-24 |
| 1770775116 | Randolph M. Stevens | Dentist | Coastal Endodontic Associates, 1804 Frederica Rd., Ste B, St. Simons Island, GA 31522 | 2007-08-09 |
| 1689797383 | Angela C Barnard | Nurse Practitioner | 798 Mallery St Apt 2, Saint Simons Island, GA 31522 | 2007-04-09 |
| 1053493486 | Larry D. Daugherty | Dentist | 124 Island Professional Park, St Simons Island, GA 31522 | 2006-10-19 |
| 1134239460 | Joe Neil Garner | Dentist | 288 Redfern Village, St Simons Island, GA 31522 | 2006-08-30 |
| Find all providers in zip 31522 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750775540 | Frederica Imaging PC | Radiology | 301 Hawkins Island Dr, Saint Simons Island, GA 31522-1506 | 2015-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326650136 | Tbi Diagnostic Centers of Georgia | Radiology | 4294 Memorial Dr Ste D, Decatur, GA 30032-1226 | 2020-08-21 |
| 1912464702 | Vickie Consuella71 Bush | Radiology | 3701 Bermuda Run Dr, Valdosta, GA 31605-1059 | 2019-02-27 |
| 1932685096 | T2 Imaging | Radiology | 1376 Church Street, Suite 100, Decatur, GA 30030 | 2018-07-12 |
| 1578061636 | Subspecialty Imaging, LLC | Radiology | 1495 Hickory Flat Hwy Ste 150, Canton, GA 30115-4229 | 2018-01-24 |
| 1205354693 | Zenith Radiology LLC | Radiology | 1059 Windermere Xing, Cumming, GA 30041-6104 | 2017-09-06 |
| 1558886341 | Synergy Radiology, LLC | Radiology | 1501 Milstead Road, Suite 140, Conyers, GA 30012 | 2017-08-14 |
| 1932624723 | M & B Imaging, PC | Radiology | 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 | 2017-08-14 |
| 1902346422 | Allegiance Imaging and Radiology LLC | Radiology | 900 Thornton Rd, Ste A, Lithia Springs, GA 30122-2641 | 2017-03-02 |
| 1518406743 | Flexogenix Georgia PC | Radiology | 4600 Roswell Rd Unit E210, Sandy Springs, GA 30342-3197 | 2017-02-21 |
| 1649727215 | Metro Imaging Cumming, LLC | Radiology | 4150 Deputy Bill Cantrell Memorial Road, Cumming, GA 30040 | 2016-09-01 |
| Find all providers with the same taxonomy | ||||
| City | SAINT SIMONS ISLAND |
| Zip Code | 31522 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.