Provider Demographics
NPI:1548357940
Name:BLANTON, DONALD W (PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:BLANTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6780
Mailing Address - Country:US
Mailing Address - Phone:334-875-4184
Mailing Address - Fax:
Practice Address - Street 1:1023 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6780
Practice Address - Country:US
Practice Address - Phone:334-875-4184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51042362OtherBLUE CROSS BLUE SHIELD