Blake, Bryan David

Blake, Bryan David is an sole proprietor health care provider with primary practice located at 939 Thornton Rd , Lithia Springs GA 30122-2634. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Blake, Bryan David can be contacted via phone (770) 948-5400.

Contact Information

Primary practice address
939 Thornton Rd Lithia Springs GA 30122-2634
Phone: (770) 948-5400
Fax: (770) 948-4930
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 040613 Georgia

Profile Details

NPI number 1316930118
LBN Legal business name Blake, Bryan David
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 26th, 2005
Last updated Jun 30th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316930118 NPPES
Georgia MEDICAID 00687409D

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