# JEANNIE BLOM MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jeannie-In-A-Bottle
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144530155
- **Authorized official:** MS. JEANNIE M BLOM M.D. (CEO)
- **Authorized official phone:** (404) 849-3443

## Contact information

- **Practice address:** 2722 N. DECATUR, DECATUR, GA 30033
- **Practice address phone:** (404) 849-3443
- **Practice address fax:** (404) 467-1004
- **Mailing address:** PO BOX 190218, ATLANTA, GA 31119-0218
- **Mailing address phone:** (866) 214-8600
- **Mailing address fax:** (678) 888-0390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 041517 | GA | Yes |

## Other

- **Enumeration date:** 10/13/2010
- **Last updated:** 12/06/2012