MR. JONATHAN BLACKMON (NPI# 1619916186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619916186 |
| Entity Type | Individual |
| Full Name | MR. JONATHAN BLACKMON |
| Credential | IDC |
| Practice Address |
603 Wild Grape Dr Saint Marys GA 31558-3619 |
| Mailing Address |
881 Uss James Madison Rd Naval Submarine Support Center Medical Department Kings Bay GA 31547-2531 |
| Practice Telephone | 9125732940 |
| Mailing Telephone | 9125732940 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-03-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 246QM0706X |
Spec/Tech, Pathology Specialization: Medical Technologist |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| Street Address |
603 WILD GRAPE DR |
| City | SAINT MARYS |
| State | GA |
| Zip Code | 31558-3619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942827332 | Primary Care of Coastal Georgia | Clinic/Center | 214a Professional Cir, St Marys, GA 31558 | 2020-07-01 |
| 1922659192 | Christian Bianca Booker | Social Worker | 944 Kings Bay Rd. #247, St. Marys, GA 31558 | 2019-09-27 |
| 1154897296 | Shonta Harper | Counselor | 708 Osborne St Ste 104, Saint Marys, GA 31558 | 2018-10-16 |
| 1174038095 | Camden Behavioral Wellness, Inc | Counselor | 605 Osborne Street, Saint Mary's, GA 31558 | 2017-12-14 |
| 1285149427 | Urgent Care of Coastal Georgia | General Practice | 214 A Professional Circle, St. Marys, GA 31558 | 2017-12-11 |
| 1679975783 | Jeremy Cole | Behavioral Analyst | 921 Charlie Smith Sr. Highway, St. Marys, GA 31558 | 2014-09-19 |
| 1053660738 | Janice Paulino Ramirez | Nurse Practitioner | 2040 Dan Proctor Drive, Suite 170, St Marys, GA 31558 | 2012-09-10 |
| 1174899454 | Light Horse Healthcare Inc | Voluntary or Charitable | 2060 Dan Proctor Drive, Suite 3300, St Marys, GA 31558 | 2012-03-30 |
| 1316215775 | Annette O. Perry | Counselor | 4019 Hwy 40 East, St. Marys, GA 31558 | 2011-12-13 |
| 1932486271 | Sarah Jo Meyers | Speech-Language Pathologist | 2015 Osborne Rd, Unit A, St Marys, GA 31558 | 2011-11-15 |
| Find all providers in zip 31558 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225156441 | David Michael Holt | Military Health Care Provider | 341 Creekside Dr, Saint Marys, GA 31558-4485 | 2007-03-26 |
| 1780640722 | Sean Mason | Military Health Care Provider | 15 Natures Bounty Trl, Saint Marys, GA 31558-3995 | 2006-04-26 |
| 1619955655 | Richard Collier Neal | Military Health Care Provider | 563 Point Peter Rd, Saint Marys, GA 31558-4470 | 2006-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033639752 | Ryan Charles Romer | Military Health Care Provider | 814 Radford Blvd Ste 20328, Albany, GA 31704-1130 | 2017-06-23 |
| 1295105773 | Christopher Lamar Davis | Military Health Care Provider | 3665 Cherry Ridge Blvd, Decatur, GA 30034-5011 | 2015-09-28 |
| 1124425376 | Cody Williams | Military Health Care Provider | 2198 Old Groveland Rd, Pembroke, GA 31321-3322 | 2014-12-03 |
| 1851625370 | Holistic Approach Wellness Center | Military Health Care Provider | 5744 Austell Powder Springs Rd, Austell, GA 30106-3231 | 2009-09-30 |
| 1275717092 | Michael Arnez Leggett | Military Health Care Provider | 1063 Uss Georgia Ave, Commander Submarine Group Ten, Kings Bay, GA 31558-2626 | 2007-12-28 |
| 1023291788 | Jay D Carson | Military Health Care Provider | 1050 Uss Gerogia Ave, Kings Bay, GA 31547 | 2007-12-17 |
| 1194904847 | George Gleason Sweeney IIi | Military Health Care Provider | 143 Laurel Marsh Way, Kingsland, GA 31548-6192 | 2007-10-30 |
| 1508045550 | Hubert Williams | Military Health Care Provider | 814 Radford Blvd Bldg 7000, Albany, GA 31704-9998 | 2007-10-26 |
| 1568651321 | Westley Michael Durnell | Military Health Care Provider | 580 Uss Mariano G. Vallejo Ave, Nssc Medical, Kings Bay, GA 31547 | 2007-10-17 |
| 1013127497 | Cory Dean Sant | Military Health Care Provider | Uss Rhode Island Ssbn 740 (blue), 1059 Uss Georgia Ave, Kings Bay, GA 31547 | 2007-05-23 |
| Find all providers with the same taxonomy | ||||
| City | SAINT MARYS |
| Zip Code | 31558 |
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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.