| Blackstone | |
|
5266 Old Highway 11 Ste 50 Hattiesburg MS 39402-7818 | |
| (678) 834-7615 | |
| Not Available |
| Full Name | Blackstone |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5266 Old Highway 11 Ste 50, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Nikki Kwona Wright (DIRECTOR) |
| Authorized Official Contact | 6788347615 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackstone 5737 Old National Hwy Ste 300 Atlanta GA 30349-3865 Ph: (678) 834-7615 | Blackstone 5266 Old Highway 11 Ste 50 Hattiesburg MS 39402-7818 Ph: (678) 834-7615 |
| NPI Number | 1801340799 |
|---|---|
| Provider Enumeration Date | 08/08/2016 |
| Last Update Date | 08/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801340799 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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