Wyatt Kenny Blake MD

NPI 1548263064 - Family Medicine - 207Q00000X

NPI Details
NPI 1548263064
Gender Male
Enumeration Date 05/30/2005
Last Updated 03/06/2013
Entity Type Individual
Active Over 11 years ago
Practice Location
545 VENTURE COURT
MONTICELLO GA, 31064, US
Phone (706) 468-7002
Fax (706) 468-7020
Business Location
545 VENTURE COURT
MONTICELLO GA, 31064, US
Phone (706) 468-7002
Fax (706) 468-7020
Toxanomy
Taxonomy Code 207Q00000X
License State Georgia
License Number 047702
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According to our database, Dr. Wyatt Kenny Blake MD NPI is 1548263064, taxonomy code is 207Q00000X and license number is 047702, license state is located at Georgia. Wyatt Kenny Blake MD physically located at 545 Venture Court, Monticello GA, 31064. NPI Number Wyatt Kenny Blake MD has the Individual type.

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1548263064 NPI number is provided on an as is basis without warranty of any kind. 1548263064 is maintained by the National Plan & Provider Enumeration System. The contents of Wyatt Kenny Blake MD are for informational purposes only.