W Kenny Blake Md Llc

NPI 1093011314 - Family Medicine - 207Q00000X

NPI Details
NPI 1093011314
Enumeration Date 02/03/2011
Last Updated 02/04/2011
Entity Type Healthcare Provider
Active Over 5 years ago
Authorized Information
Name WYATT K WYATT
Position OWNER
Phone (706) 468-7002
Fax (706) 468-7020
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
License Number
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According to our database, W Kenny Blake Md Llc NPI is 1093011314, taxonomy code is 207Q00000X W Kenny Blake Md Llc physically located at 545 Venture Court, Monticello GA, 31064. NPI Number 1033115704 has the healthcare provider type.

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1093011314 NPI number is provided on an as is basis without warranty of any kind. 1093011314 is maintained by the National Plan & Provider Enumeration System. The contents of W Kenny Blake Md Llc are for informational purposes only.