# JEANNIE-IN-A-BOTTLE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jeannie Blom
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871759233
- **Authorized official:** MS. JEANNIE M BLOM M.D. (CEO)
- **Authorized official phone:** (404) 849-3443

## Contact information

- **Practice address:** 3620 HOWELL FERRY RD, DULUTH, GA 30096-3178
- **Practice address phone:** (678) 312-6800
- **Practice address fax:** (678) 312-5622
- **Mailing address:** 1343 CANTON RD STE C, MARIETTA, GA 30066-6079
- **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:** 08/05/2008
- **Last updated:** 05/22/2013